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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Code for Ireland’s Covid Tracker app given to global public health project
The code for Ireland’s Covid Tracker app has been published as part of an open source programme to help global public health authorities tackle the pandemic.
Andrea Downey – July 23, 2020
Ireland’s Health Service Executive has provided the code to the newly established Linux Foundation public health initiative which aims to use open source software to help public health authorities around the world combat Covid-19 and future epidemics.
Fran Thompson, chief information officer of the HSE, said: “We are pleased to contribute Covid Green, the open source code behind Ireland’s Covid Tracker app, to Linux Foundation Public Health.
“This app is a great demonstration of innovation within the Irish health sector combined with the IT capabilities of the Irish software industry. We’re immensely proud of the work we’ve undertaken in partnership with NearForm in responding to the pandemic.
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NH Permanently Extends Telehealth Coverage, Including Payment Parity
New Hampshire Governor Chris Sununu has signed a new law that, among other things, establishes telehealth reimbursement parity, permits phone-based care and expands telehealth use in substance abuse treatment.
July 23, 2020 - New Hampshire has enacted a new law that greatly expands how care providers in the Granite State can use telehealth.
HB 1623, signed on July 21 by Governor Chris Sununu, amends the state’s definition of telemedicine to include new modalities, including audio-only phones, and requires Medicaid and private payers to reimburse for telehealth services on the same basis that it reimburses for in-person care.
It also ends restrictions on originating and distant sites for telehealth services, and expands the list of care providers able to use telehealth to encompass physicians, physician assistants, advanced practice nurses, midwives, psychologists, allied health professionals, dentists, mental health practitioners, community mental health providers employed by community mental health programs, alcohol and other drug use professionals, dietitians and professionals certified by the national behavior analyst certification board.
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https://healthitanalytics.com/news/3-ways-predictive-analytics-is-advancing-the-healthcare-industry
3 Ways Predictive Analytics is Advancing the Healthcare Industry
The industry is ramping up its use of predictive analytics, leveraging these tools to get ahead of disease and improve patient care.
By Jessica Kent
July 21, 2020 - As the healthcare industry has increasingly aimed to deliver proactive, quality care, predictive analytics models have emerged as viable tools for improving outcomes and cutting costs.
From mapping the spread of infectious diseases, to forecasting the potential impact of certain conditions, predictive analytics tools can help organizations stay one step ahead in an unpredictable industry.
Researchers and provider organizations are applying predictive analytics techniques to improve practices across the care continuum, leading to more informed decision-making and better patient care.
Forecasting the spread of COVID-19
Throughout the COVID-19 pandemic, predictive analytics models have played a major role in helping healthcare leaders track and prepare for the spread of the virus.
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AI-based lung infection score triages COVID-19 patients, predicts near-term needs
Matt O'Connor | July 23, 2020 | Artificial Intelligence
A new neural network-based algorithm proved capable of measuring pulmonary disease severity on radiographs taken from patients with COVID-19, authors reported Wednesday. It may serve as a tool to help clinicians triage those with the disease.
That’s according to researchers from Massachusetts General Hospital, who trained their convolutional model on thousands of images and tested it on chest x-rays from various hospitals. The resulting pulmonary x-ray severity, or PXS score, aligned with radiologists’ mark-ups and follow-up interpretations.
Writing July 22 in Radiology: Artificial Intelligence, the authors say their automated method can help track the disease and predict intubation or death.
And first author Matthew D. Li, MD, with MGH’s biomedical imaging center, and colleagues see a number of additional uses for PXS scoring during the current pandemic.
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Many U.S. Homes Too Cramped to Stop COVID-19's Spread
By Amy Norton
HealthDay Reporter
FRIDAY, July 24, 2020 (HealthDay News) -- People with COVID-19 are told to keep their distance from family members to protect them from infection. But a new study finds that one-fifth of U.S. homes are too small for that to happen.
Researchers found that more than 20% of households nationwide lacked enough bedrooms and bathrooms to allow a person with COVID-19 to isolate. That covers roughly one-quarter of the population.
And as with the pandemic in general, minority and low-income Americans are most affected. Among Hispanic adults, close to 40% live in a home with too few bedrooms or bathrooms.
Experts said housing conditions are likely one reason that Black and Hispanic Americans have been especially hard-hit during the COVID-19 pandemic.
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https://ehrintelligence.com/news/the-sequoia-project-launches-information-blocking-boot-camp
The Sequoia Project Launches Information Blocking Boot Camp
Prior to the deadline to comply with the ONC interoperability rule, the Sequoia Project has developed the Information Blocking Compliance Boot Camp for healthcare organizations and health IT developers.
July 24, 2020 - The Sequoia Project has created the Information Blocking Compliance Boot Camp and free public resource center to help prepare and train healthcare and health IT organizations for the November 2, 2020 deadline to comply with The Office of the National Coordinator for Health IT (ONC) interoperability rule.
The Information Blocking Compliance Resource Center, which is the home to the Information Blocking Compliance Boot Camp, provides free tools, reports, checklists, and webinars for its users.
“In this unique time of the pandemic, we know our members and the rest of the healthcare community are stretched thin,” Mariann Yeager, CEO of The Sequoia Project, said in a statement.
“We hope these free tools and value-priced training program will outline practical, implementation-focused steps to preparing to meet the November 2nd compliance deadline.”
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U.S. Postal Service Address Sorter Sought for Contact Tracing
July 24, 2020, 8:45 PM
- Mismatched patient data thwarts Covid-19 tracking
- Senator asks HHS, USPS to negotiate in sharing online tool
The post office’s method of sorting and standardizing addresses could be a powerful tool to track the spread of the coronavirus.
Public health authorities use patients’ electronic health data—phone numbers, addresses, and dates of birth—to trace the spread of Covid-19 from those infected with the virus to people that could potentially be exposed to it, also known as contact tracing.
The U.S. Postal Service’s address formatting database could help doctors and electronic health record vendors sort patients’ addresses in a uniform way through the agency’s free online address tool, now used to make sure that packages are more efficiently shipped to homes and businesses.
“The response to this pandemic is really an all-hands-on-deck approach across government, and updating the address standardization tool to allow its use in health care would represent an opportunity to further contribute,” said Ben Moscovitch, health information technology project director at The Pew Charitable Trusts.
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Roundup: UK’s test and trace failing to contact thousands, France deploys AI-based cancer detection and more briefs
Also, Ireland donates its contact tracing app to Linux Foundation.
By Sara Mageit
July 24, 2020 06:05 AM
FRANCE DEPLOYS AI-BASED CANCER DETECTION
AI-based cancer diagnostics company, Ibex Medical Analytics, and network of private pathology labs in France, Medipath, have announced the deployment of an AI-powered platform for cancer detection in pathology in France.
This coincides with a global decline in the number of pathologists and increased workloads.
The process of lab cancer diagnosis through a microscope is manual and thus prone to human error. Ibex offers a clinical grade, field proven AI-based solution that helps pathologists meet these challenges.
Medipath has completed deployment of Ibex’s Galen Prostrate as part of its routine clinical practice.
With Ibex’s CE-marked solution, an AI algorithm analyses prostate biopsies and raises alerts when discrepancies with the pathologists’ initial diagnosis are identified.
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https://www.healthcareitnews.com/news/cerner-holon-partner-decision-support-automation
Cerner, Holon partner on decision support automation
Holon's CollaborNet technology will deliver analytics data from Cerner’s HealtheIntent population into clinical workflows.
By Mike Miliard
July 24, 2020 11:25 AM
Holon Solutions and Cerner on Thursday announced that they'll jointly deploy patented technology to automate delivery of patient data from Cerner’s EHR-agnostic HealtheIntent population to keep clinicians informed about relevant health information.
WHY IT
MATTERS
The aim is to deliver needed contextual information directly to clinicians
within their EHR workflow, according to the companies, and eliminate the need
to spend time combing through numerous different data sources for information
that might inform care decisions.
Holon’s CollaborNet tool can detect provider workflow activity. It is able to surface relevant patient information and identify gaps in care in a display that runs alongside the patient chart, according to the company, enabling a faster and less intrusive delivery of decision support.
THE
LARGER TREND
All month long, Healthcare
IT News is focused on the theme of actionable intelligence, exploring the many ways data and
analytics are being harnessed and put to work toward the aim of more effective
and efficient care delivery.
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https://www.irishexaminer.com/lifestyle/healthandwellbeing/arid-40020920.html
Top apps to keep your health and wellbeing on track
With so many on the market, it can be difficult to know which health apps are safe to use. We get advice from the experts
Friday, July 24, 2020 - 06:00 AM
Peta Bee
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https://healthitsecurity.com/news/top-risks-of-1h-2020-ransomware-mobile-health-infrastructure
Top Risks of 1H 2020: Ransomware, Mobile, Health Infrastructure
Fueled by COVID-19, Skybox Security predicts over 20,000 vulnerability reports by the end of 2020, as hackers ramp up ransomware and health infrastructure and mobile device attacks.
July 22, 2020 - The first half of 2020 has seen a spate of cyberattacks fueled by the COVID-19 pandemic with a spike in ransomware samples and mobile vulnerabilities, as well as a host of targeted attacks on critical infrastructure, including healthcare companies and research labs, according to a Skybox Security report.
For its mid-year 2020 Vulnerability and Threat Trends Report, researchers analyzed a range of security feeds, dark web investigations, and other sources, in addition to manual and automated analyses to assess attack trends, cyber events, and attackers' tactics, techniques, and procedures.
The report is designed to shed light on the vulnerabilities being exploited in the wild and other attack trends. These threats have rapidly expanded during the COVID-19 pandemic, fueled by the response and an increase in remote work.
Researchers predict that by the end of 2020 there will be well over 20,000 new vulnerability reports.
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https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/87685
Prioritizing Mental Health Shouldn't Be Risky for Physicians
— The scale of suffering and death is taking a large psychological toll
by Leigh Vinocur, MD July 22, 2020
As an emergency physician on the frontlines of the pandemic, initially I feared for the safety of my friends and colleagues because of personal protective equipment shortages and direct exposure to COVID-19. But there is a hidden side effect of the virus that will be just as dangerous, although likely underreported -- physicians' mental health.
We knew a pandemic could be our health system's tipping point, but the scale of suffering and death, the likes of which most of us have never seen before, is taking a large psychological toll on professionals on the frontline. We face stress and grief at work, and then many of us remain isolated from our homes and our support systems, causing more anxiety and depression. While we try to compartmentalize all the suffering we see as emergency physicians, we are human, and it affects us all.
Physicians have one of the highest suicide rates of any profession, and female doctors are even more at risk. Emergency medicine in particular is incredibly stressful and known for high burnout rates.
Emergency physicians feel we need to be superhuman while on shift, but many friends and colleagues have admitted to me during this pandemic that the hardest part of the day is when they finish their shifts and they are alone, processing the day's pressure, stress, and grief.
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https://ehrintelligence.com/news/how-hospitals-can-boost-health-it-safety-to-achieve-accreditation
How Hospitals Can Boost Health IT Safety to Achieve Accreditation
Health IT experts from Pew Charitable Trusts and MedStar Health scripted a list of best practices for health IT safety for CMS and the Joint Commission to integrate into accreditation.
July 22, 2020 - The Pew Charitable Trusts and MedStar Health, the largest healthcare provider in Maryland and Washington DC, are requesting Centers for Medicare & Medicaid Services (CMS) and the Joint Commission to make health IT safety a priority for hospitals that seek accreditation.
The report offers a list of best practices for hospitals to integrate, which could be incorporated into accreditation requirements from an agency, such as the Joint Commission.
“Hospitals—like organizations in many industries—benefit from the adoption of best practices that help improve the quality and safety of the services they offer,” wrote the report authors. “However, in many cases, health care facilities fail to use established best practices because of competing priorities, regulatory demands, and other factors.”
“To encourage adoption of practices known to improve care quality and safety, the federal government and organizations that accredit hospitals, such as The Joint Commission, can set safety-related standards that hospitals must meet,” the authors continued.
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https://www.healthcareitnews.com/news/when-integrating-ehr-and-telehealth-one-size-doesnt-fit-all
When integrating EHR and telehealth, one size doesn't fit all
Experts at this week's Telehealth Innovation Forum urged health systems to consider how different vendors might meet their unique needs.
July 23, 2020 01:59 PM
The explosion of telehealth in response to the COVID-19 pandemic has triggered, in turn, conversations about how to achieve seamless electronic health record integration.
Some telehealth platforms offer agnostic integration with a host of EHR systems, while some EHRs offer their own in-house telehealth option.
What works for one system won't necessarily be right for another, suggested panelists at Wednesday's Teladoc-sponsored Telehealth Innovation Forum.
When selecting an EHR vendor, or contemplating a switch, there are several factors to weigh, argued Dr. Simon Samaha, cofounder of Kentan Staffing Solutions.
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https://healthitsecurity.com/news/doj-accuses-china-of-targeted-hacking-on-covid-19-research-data
DOJ Accuses China of Targeted Hacking on COVID-19 Research Data
Two hackers are accused by DOJ of working with the Chinese government to target and hack hundreds of US entities, stealing more than a terabyte of data, including COVID-19 research.
July 21, 2020 - The Department of Justice has indicted two hackers for allegedly working with the government of China to target and hack hundreds of US companies, governments, organizations, and others in a global intrusion campaign, designed to steal valuable information, including COVID-19 research.
The cybercriminals are accused of stealing more than a terabyte of data through what DOJ officials described as a sophisticated and prolific threat to US networks.
COVID-19 research data would be highly valuable on the dark web, given the global efforts focused on finding a vaccine or treatment for the coronavirus. In fact, the indictment comes on the heels of a report showing Russian hackers known as Cozy Bear targeting US COVID-19 research firms to steal or destroy valuable information in a similar fashion.
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https://healthitsecurity.com/news/dhs-shares-insights-on-network-tunneling-obfuscating-cyberattacks
DHS Shares Insights on Network Tunneling, Obfuscating Cyberattacks
Threat actors leverage obfuscation, network tunneling, and spoofing techniques to mislead incident responders. New DHS CISA insights shed light on these cyberattack methods.
July 20, 2020 - Recent insights from the Department of Homeland Security Cybersecurity and Infrastructure Security Agency shed light on recent cyberattacks that leverage network tunneling and spoofing techniques to obfuscate geolocation and attribution.
The threat overview comes on the heels of a joint alert from the FBI and CISA warning of cyberattacks originating from Tor (The Onion Router), which allows hackers to anonymously launch cyberattacks and other malicious cyber activities.
Cyberattacks that use network tunneling and spoofing techniques makes it difficult for security leaders to attribute malicious cyber activity, as it requires the analysis of location and other variables.
An IP address’s geolocation is typically obtained through publicly available information, although the precision of this data varies across sources: “some provide country and locality details, while others provide neighborhood-level detail.”
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https://ehrintelligence.com/news/electronic-case-reporting-promotes-interoperability-during-covid-19
Electronic Case Reporting Promotes Interoperability During COVID-19
Sutter Health has implemented an electronic case reporting tool into its EHR to automate a previously burdensome process.
July 21, 2020 - At Sutter Health, a major health system headquartered in Northern California, public health reporting was once a manual and burdensome process. However, implementing a clinical direct messaging tool in the EHR has enhanced the electronic case reporting (eCR) process and increased interoperability between the provider and public health agencies.
eCR is the automated production and submission of reportable diseases and conditions from the EHR to public health agencies, according to the Center for Disease Control & Prevention.
eCR is made up of data from The Association of Public Health Laboratories (APHL), the Council of State and Territorial Epidemiologists (CSTE), and the CDC each play a role in facilitating eCR. Specifically, they work with providers in reporting certain conditions, as well as the public health agencies and vendors that enable eCR.
Although public health agencies see the importance of a clinical direct messaging service that enables safe and secure transmission of eCR, there is a widescale public health need to for agencies to take the next step to accept, receive, and integrate eCR data into their workflow.
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Team Uncovers Genetic Variants that Impact COVID-19 Susceptibility
Cleveland Clinic researchers have found genetic variants that may influence an individual’s susceptibility to COVID-19.
By Jessica Kent
July 20, 2020 - Genetic variants may play a role in a person’s susceptibility to COVID-19, leading to a better understanding of which populations are most at risk of severe complications from the virus, according to a study published in BMC Medicine.
Although the majority of COVID-19 cases result in mild symptoms, the virus does have a severe impact on certain patient populations. Morbidity and mortality rates rise significantly with age and co-existing health conditions, such as cancer and cardiovascular disease. However, even young and otherwise healthy people can experience severe illness and death.
There is some indication that genetic factors may impact COVID-19 susceptibility, but these factors remain largely unknown.
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International collaboration on digital health best practice supports global response to COVID-19 pandemic
Four reports – White Papers – have been published by the Global Digital Health Partnership (GDHP) of over 30 nations including Australia detailing what GDHP member countries are doing to deliver digital health services and improve patient health outcomes.
The GDHP is currently chaired by India. Mr Lav Agarwal, Joint Secretary, Ministry of Health and Family Welfare, Government of India is the GDHP Secretariat Lead.
Mr Agarwal said “Sharing digital health information is now more important than ever as individual nations and the global community respond to the challenges of the COVID-19 pandemic.”
“These White Papers will provide both participant and non-participant countries and territories with guidance on the key digital health enablers that can lead in improving the health and well-being of citizens at national and sub-national levels through the best use of evidence-based digital technologies.”
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WatchOS 7: Soon, your Apple Watch will know just how fit you really are
WatchOS 7, due to arrive this fall, brings new metrics that can reveal a lot about your overall health and can monitor fitness levels as you age.
The Apple Watch may be able to predict how healthy or unhealthy you are and keep you in check as you age. WatchOS 7, the next version of Apple's wearable software due to arrive in the fall, will bring a new set of mobility metrics to the Watch. They could provide a snapshot of a person's physical and cardiovascular fitness, and with the help of a physician, detect more serious health conditions.
Mobility, or functional capacity as it's known in the medical world, is one of the best indicators of overall health and longevity. Mobility decreases as we age, but it can
"Preserving or improving functional capacity is one of the most important things we do as physicians," says Dr. Nauman Mushtaq, an Interventional Cardiologist at Northwestern Medical Group.
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Here is how execs from Oscar Health, Intermountain and Cerner say the telehealth boom will change healthcare
Jul 22, 2020 10:50am
The COVID-19 pandemic has accelerated the adoption of telehealth and there is a general consensus, including from White House leaders, that virtual care is here to stay.
In response to the COVID-19 pandemic, the Trump administration has opened up access to telehealth with sweeping—but temporary—changes to reimbursement policies.
"Rather than just wholesale transformation, we have experienced an acceleration around transformations that were already underway," said Ryan Smith, chief information officer, Intermountain Healthcare, during a virtual event hosted by media company Protocol.
"With telehealth expansion we have transitioned from it being a disruptive technology and care delivery model to overnight being almost a normal part of healthcare delivery," he said.
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https://www.the-scientist.com/news-opinion/big-data-and-collaboration-seek-to-fight-covid-19-67759
Big Data and Collaboration Seek to Fight Covid-19
Researchers try unprecedented data sharing and cooperation to understand COVID-19—and develop a model for diseases beyond the coronavirus pandemic.
Emma Yasinski
Jul 21, 2020
Although cough and fever have been considered the most tell-tale signs of COVID-19, in May, researchers published a study suggesting that loss of smell and taste were better able to predict who would test positive for the disease. The insight came from data shared by millions of individuals who logged on to a phone app to report what, if any, symptoms they were experiencing on a given day.
The Covid Symptom Tracker app now has nearly 4 million users. Researchers are extracting the massive amounts of data they gather to anticipate COVID-19 outbreaks in particular communities and to explore different risk factors for the disease.
“We were one of the earliest bodies to actually identify the importance of a loss of taste or smell as a predictor,” says Andrew Chan, a physician and epidemiologist at Massachusetts General Hospital and the lead researcher on the project. “We developed the Covid Symptom study app as a means of rapidly collecting data on a large population of individuals, to gather real-time information about COVID in the setting of a rapidly unfolding pandemic.” The app has helped scientists understand the risks healthcare workers face as well as the effects of some underlying factors such as obesity and diabetes. The data aren’t readily available to any researcher, but the team has developed a number of partnerships with those conducting clinical trials and longitudinal research, and is “interested in partnering with investigators who are taking a different approach to COVID,” says Chan.
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https://edition.cnn.com/2020/07/21/health/covid-19-three-things-will-stop-it-wellness/index.html
Three simple acts can stop Covid-19 outbreaks, study finds
Updated 0750 GMT (1550 HKT) July 22, 2020
CNN)If people washed their hands regularly, wore masks, and kept their social distance from each other, these three simple behaviors could stop most all of the Covid-19 pandemic, even without a vaccine or additional treatments, according to a new study.
The study, published Tuesday in the journal PLoS Medicine, created a new model to look at the spread of the disease and prevention efforts that could help stop it.
The contact rates in the study were based on people's interaction in the Netherlands, but the model is appropriate for other Western countries, the researchers at the University Medical Center Utrecht said
"A large epidemic can be prevented if the efficacy of these measures exceeds 50%," they wrote.
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https://www.nytimes.com/2020/07/21/health/coronavirus-data-states-cdc.html
States Must Standardize Coronavirus Data, Former C.D.C. Director Says
Dr. Thomas Frieden proposed uniform reporting guidelines for states. Experts said the C.D.C. should have done it months ago.
· July 21, 2020
As criticism of the Trump administration’s response to the coronavirus pandemic intensifies, a former director of the Centers for Disease Control and Prevention on Tuesday called on state health officials to start reporting coronavirus data in a detailed and uniform fashion, rather than the disorganized hodgepodge most states now produce.
Other public health experts said that such guidelines were long overdue and that the agency’s current director, Dr. Robert Redfield, should have mandated them months ago.
The lack of clear C.D.C. guidance — even on simple issues like data collection — was an example of the administration’s ineptitude and ineffective leadership in the face of a growing crisis, experts said.
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U.S. COVID-19 Cases Could Be Way Beyond 'Official' Count, Study Finds
By Dennis Thompson
HealthDay Reporter
TUESDAY, July 21, 2020 (HealthDay News) -- Far more Americans have been infected with COVID-19 than reported case counts reflect, a new government report suggests.
COVID-19 infections were anywhere from six to 24 times higher than the number of reported cases in 10 different sites across the United States tested at different times during the pandemic, the U.S. Centers for Disease Control and Prevention study found.
In seven U.S. locales, there were more than 10 times the number of COVID-19 infections than there were reported cases, antibody testing led by Dr. Fiona Havers, of the CDC's COVID-19 Response Team, revealed.
"The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population," the researchers concluded.
The findings were published July 21 in the journal JAMA Internal Medicine.
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Failing states of health - How broader collaboration can bring us closer to the future of health
Without cross-border co-operation the potential of personalised health cannot be realised, acccording to Bogi Eliasen, director at the Health Copenhagen Institute for Futures Studies.
By Bogi Eliasen
July 22, 2020 03:08 AM
While the COVID-19 pandemic has seen some countries respond well to the ongoing health crisis for their own populations, it has also – despite decades of increasing and accelerating globalisation – shown how quickly countries can turn inwards. As countries around the world entered states of emergency and enacted extraordinary measures to contain the spread of COVID-19, they have in many instances also reverted to a ‘city-state’ logic, strictly limiting their attention within their borders and not daring to opt into common solutions that very likely would have been better, which will be discussed in more detail at the HIMSS & Health 2.0 European Digital Event in September.
Disappointingly, our leaders and international political institutions have both failed to stand together and provide strong frameworks for collaboration throughout the COVID-19 crisis, while other organisations and actors like businesses and researchers have in many ways worked to intensify and deepen cross-border collaboration. As we look cautiously to the end of the first wave of the crisis in some parts of the world, we must consider how sustainable these cross-border relationships are, who can and should take the lead in defending and cultivating them, and what benefits they can provide for the future of healthcare – particularly in relation to the emerging personalised health paradigm. Given the recent experience, the notion that states will lead this charge may be met with a degree of scepticism.
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Error which caused 80,000 German medical practices to lose their connection to telematics infrastructure has been resolved
Doctors were not able to transfer patient master data via the system for eight weeks due to a configuration error.
By Tammy Lovell
July 22, 2020 06:35 AM
A configuration error which led to 80,000 German medical practices losing their connection to the telematics system has now been resolved, according to Gematik, the society for telematics applications.
The telematics infrastructure (TI) is the backbone of the German digital healthcare system, supporting data communication between all stakeholders including insured patients, healthcare providers and insurers who pay for healthcare services.
Due to a deficiency in the security architecture, the insured master data system was partially disrupted from 27 May this year, meaning that for around eight weeks doctors were not able to transfer patient master data.
Around 130,000 affiliated medical practices and clinics in Germany use the TI to compare the master data of their patients with the health insurance companies via special security routers - called connectors.
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Online GPs could save employers £1.5 billion in lost working time, according to report
Researchers say remote consultations could reduce the number of cancelled appointments and no shows.
By Tammy Lovell
July 22, 2020 01:43 AM
Employee travel to GP appointments cost UK businesses an estimated £1.5 billion in lost working time last year, says a report published by the health insurance firm AXA PPP Healthcare today.
The report, Digital health: the changing landscape of how we access GP services, produced by the Centre for Economics and Business Research (CEBR), highlights the role that online GPs could play in boosting efficiencies across business and healthcare.
Researchers estimate that if virtual GP appointments had been offered as a first point of call across all public GP practices in 2019, face-to-face consultations could have been reduced by 50 million.
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Experts predict support for some, but not all, telehealth expansion measures
Among the takeaways at this week's Telehealth Innovation Forum: Those hoping for long-term state licensure waivers across the board may be in for disappointment.
By Kat Jercich
July 22, 2020 10:21 AM
An expert panel convened at Tuesday's Teladoc-sponsored Telehealth Innovation Forum predicted changes to the originating and geographic site requirements for telehealth – but not to state licensure waivers allowing physicians from one state to practice in another.
Although licensure waivers have been of particular importance during the COVID-19 pandemic, Claudia Duck Tucker, vice president of government affairs at Teladoc, predicted that, on that topic, at least, "everything will go back to pre-COVID."
The waivers, which were largely issued by governors' office and boards of medicine, "came with a specific start date and a specific end date," said Tucker. "Some states have extended the life of those, but when the emergency is over, everything will go back to pre-COVID days."
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Quick pivot to new HHS COVID-19 reporting rules meant 'chaos' for hospitals
Many health systems had just two days to expand or overhaul their COVID-19 patient-data-reporting practices, according to leaders from more than 10 state hospital associations.
By Kat Jercich
July 22, 2020 01:31 PM
A flurry of controversy erupted this past week following the publicization of a Trump administration directive to hospitals to bypass the Centers for Disease Control and Prevention when reporting COVID-19 patient data.
Public health experts and industry groups have expressed concerns that the process, which gives the reins to the U.S. Department of Health and Human Services, would lead to politicization of vital real-time information.
Last Wednesday, HHS and CDC held a joint press call in which they described their hopes for transparency and flexibility under the system. The American Hospital Association has told its members to report the information to HHS as requested, emphasizing that "the daily reporting is the only mechanism used for the distribution calculations" of remdesivir or any other treatments or supplies.
In other words, although reporting is technically voluntary, doing so will be vital in the future for health systems' access to COVID-19 resources.
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Use Cases and Project Plans are not Enough – A CIO’s guide to Failure Mode and Effects Analysis
July 22, 2020
When many of us started in healthcare IT, it was before the days of pervasive Electronic Medical Records. The largest employer in Kansas City wasn’t Cerner. Paper ruled the day in hospitals. Data Processing was used to print up massive reports so that residents and doctors could accomplish their daily tasks. PACS systems weren’t pervasive yet. There were much less dependencies on electronic systems to get through the day.
With the numerous technical epochs that have occurred in rapid succession since the days of paper, the complexity of the technology that now powers a hospital or health system has increased exponentially. With this increase comes a corresponding one for risk of failure. With every change, we increase the probability of something failing.
Many of us have developed our careers in an environment where failure is not an option. It has been a career limiter to many when adverse events with system implementations occur. One item has come up repeatedly when I do post-mortem analyses. We are dealing with systems of such complexity that failure at some point is inevitable, and we have to plan for it.
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Interoperability Between Hospitals and EMS is a Light Switch Away
July 22, 2020
The following is a guest article by Emily Burch Harris, Freelance Health Writer.
DirectTrust recently hosted their second annual Summit (recordings still available), an event focused on connecting DirectTrust members and non-members with some of the nation’s greatest healthcare and interoperability experts.
“One outstanding session was A Case Study in Automated Data Exchange Between EMS and Hospitals submitted by Kno2, a longstanding member and contributing participant,” said Scott Stuewe, president and CEO of DirectTrust. “Their approach to interoperability with efficient and affordable ways to drive connectivity using existing healthcare exchange standards is innovative and we’re thrilled to have shared this use case with attendees.”
Alan Swenson, VP of Interoperability for Kno2, led the introduction of speakers who included Dane Meuler of Kno2, Tiffany Moran of Roanoke Fire and EMS, and Michael Patock of ImageTrend. These IT and EMS professionals gathered to discuss how Carilion Clinic and their surrounding Emergency Medical Services (EMS) agencies improved the transmission of data.
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https://en.delfi.lt/politics/overnight-attempts-fail-to-restore-e-health-system.d?id=84822525
Overnight attempts fail to restore e-health
system
Wednesday, July 22, 2020
Overnight
attempts have failed to completely restore the e-health system in Lithuania
after it went down following Monday's rainstorm, the Center of Registers told
BNS on Wednesday morning.
"A number of registries were restored last night. Nevertheless, overnight
attempts to fully restore the e-health system have been unsuccessful so far and
they are continuing," Mindaugas Samkus, spokesman for the Center of
Registers, said, adding that it's hard to estimate when the system will be
restored.
"Speaking of a system of that scope and complexity, it’s hard to estimate. The system's data is being recovered at the moment and then we will need to check if the system can run properly. We are making every effort for this important system to resume operation as soon as possible," Samkus said.
The system went down following Monday's rainstorm when the Center of Registers' servers were damaged by a leaking pipe, leading to a failure of many systems run by the center.
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The Key to Improving Medical Device Security is Collaboration, Visibility
Manufacturers, healthcare delivery organizations, policymakers, and even patients need collaboration to better understand and address medical device security risks and improve visibility.
July 16, 2020 - The recently reported Ripple20 vulnerabilities found in more than 52,000 medical device models that could allow for remote code execution, highlight the need for greater collaboration between healthcare delivery organizations, manufacturers, and other entities to improve response time to critical flaws and fuel a more coordinated response.
Awareness around medical device security has drastically improved in recent years, as security researchers have continued to spotlight just how easy it would be for a hacker to break into a device and disrupt its function.
However, many providers are still struggling to keep pace with the continual stream of vulnerability disclosures and necessary patch management.
For Kelly Rozumalski, Booz Allen’s Secure Connected Health Director, to move the needle on medical device security, providers need to better understand the risk extends beyond data security.
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Predictive Analytics Model Examines Droplets to Map COVID-19 Spread
A predictive analytics model can help researchers better understand how respiratory droplets contribute to the spread of viruses like COVID-19.
By Jessica Kent
July 21, 2020 - A predictive analytics model showed that without masks, six feet of social distance may not be enough to keep one person’s respiratory droplets from reaching someone else, which could contribute to the spread of viruses like COVID-19.
In a study published in the journal Physics of Fluids, a team of international researchers set out to better understand the role that droplet clouds play in the spread of respiratory viruses. Respiratory droplets released when people sneeze, cough, or talk contribute to the spread of COVID-19 and other viruses, the researchers noted.
The team applied existing models for chemical reactions and physics principles to droplets of a salt water solution, which they studied in an ultrasonic levitator to determine the size, spread, and lifespan of these particles in various environmental conditions.
Researchers found that respiratory droplets travel farther and last longer in humid, cold climates than in hot, dry ones. At 95 degrees Fahrenheit and 40 percent relative humidity, a droplet can travel about eight feet. However, at 41 degrees Fahrenheit and 80 percent humidity, a droplet can travel up to 12 feet.
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HHS unveils new coronavirus hospitalization database, says it’s more complete than CDC’s
Published Mon, Jul 20 20205:07 PM EDT Updated Mon, Jul 20 20206:01 PM EDT
Key Points
- The Trump administration on Monday unveiled a new website of Covid-19 hospitalization data that officials said offers a more complete picture of the outbreak than the data previously compiled by the CDC.
- Hospitals are now instructed to report data through a new portal with the Department of Health and Human Services.
- At least some of the raw data will be available to the public, including third-party researchers, Jose Arrieta, HHS’ chief information officer, said.
The Trump administration on Monday unveiled a new website of Covid-19 hospitalization data that officials said offers a more complete picture of the outbreak than the data previously compiled by the Centers for Disease Control and Prevention.
The administration instructed hospitals last week to stop reporting to the CDC’s long-standing National Healthcare Safety Network, which provides officials “with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.” Instead, hospitals were instructed to report such data through a new portal with the Department of Health and Human Services.
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WA Health information so insecure it was published for months by teenage 'script kiddie'
By Nathan Hondros
Updated July 21, 2020 — 2.47pm first published at 12.09pm
An unencrypted pager network had been used by WA Health for more than 12 years before it was accessed by a 15-year-old boy from Mandurah, who published confidential messages for months before police intervened on Monday night.
Sensitive medical details of hundreds of West Australians and government department communications were published on a website operated by the self-described "script kiddie" using tools widely available on the internet.
A 15-year-old Mandurah boy is allegedly the mastermind behind a massive data breach that compromised thousands of medical records in Western Australia.
Premier Mark McGowan said he was disappointed and disturbed by the privacy breach, but police had intervened to shut down the website and speak to the teenager.
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https://www.medscape.com/viewarticle/934128
Patients Usually Understand and Agree With Physicians' Notes
Given an opportunity to see physicians' notes about their visits, patients mostly understand and agree with them, a survey shows.
Overall, 93% of respondents said the notes accurately described the visit; only 6% reported that something important was missing, write Suzanne G. Leveille, RN, PhD, of the University of Massachusetts, in Boston, and colleagues in The Journal of General Internal Medicine.
"I think it's wonderful news," commented Howard Levy, MD, PhD, who spearheaded the implementation of open notes at Johns Hopkins University. "I'm thrilled with this report."
Currently, 50 million Americans have access to their notes, the researchers report. Starting November 2, 2020, the 21st Century Cures Act will require all US physicians to provide this access.
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Froedtert uses digital health therapeutics to improve patients’ mental health
The Wisconsin health network prescribes apps through its Epic EHR to help patients successfully combat depression and anxiety.
By Bill Siwicki
July 21, 2020 12:29 PM
Mental health conditions often are under-diagnosed and under-treated. Screening for conditions in the primary care space can be helpful for detecting struggles or concerns that patients may not immediately feel comfortable voicing, or that are important but not the main agenda item for the patient and clinician.
THE PROBLEM
Data shows that at least 1 in 5 people has a diagnosable mental health condition. But in most cases, there is a mismatch between demand for services and their supply.
When the Froedtert & Medical College of Wisconsin Health Network instituted routine depression screenings, it knew that it needed to have options to help its providers meet the mental health needs of patients.
It had looked to SilverCloud as a major player in the digital mental health space, which provides a scalable way to help meet the demand for services, and could be used either as a primary strategy or as a supplement or bridge to in-person treatment by a specialist, said Dr. Bradley Crotty, chief digital engagement officer and an internist at Froedtert.
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Phishing: Email fraudsters are impersonating colleagues, customers, and vendors, report says
Nearly a third of professionals said they have to remediate email-based attacks every day, GreatHorn found.
The latest form of business email phishing attacks involve impersonating familiar senders, a GreatHorn report found. More than a third (36%) of respondents said they are seeing email threats coming into their inboxes every day.
Professionals are relying on email correspondence more than ever as they adjust to working from home during the coronavirus pandemic. However, cyberattackers also noticed this trend. Between February and March, researchers identified a whopping 667% increase in coronavirus-related email phishing campaigns, Barracuda Networks found.
GreatHorn also acknowledged this uptick, however, the report noted that this view isn't fully adequate in understanding how phishing email attacks are evolving, and how security teams are responding to those threats.
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https://www.digitaltrends.com/computing/ufo-super-vpn-apps-data-leak/
Seven VPN apps accused of exposing more than a terabyte of private data
Shubham Agarwal July 19, 2020 10:10PM PST
A group of free VPN apps reportedly exposed a treasure trove of private data of millions of users. Discovered by vpnMentor, a total of seven VPN providers, all of which explicitly claimed they didn’t record their users’ activities, left more than a terabyte of browsing logs out in the open for anyone to access.
The leaked data silo housed a wide range of sensitive data, some of which was personally identifiable too. VpnMentor claims it included records of the websites users visited, plain-text passwords, PayPal payment information, device specifications, email addresses, and more.
While the data since then has been taken down, vpnMentor was independently able to confirm the data was channeled from these VPN apps by browsing through new accounts and cross-verifying it with the updated database.
In addition, all of the affected VPN apps are owned by the same Hong Kong-based parent company and were simply rebranded versions of the same VPN service. They were distributed under variations of generic names such as Super VPN, Fast VPN, Flash VPN, and more — a pattern commonly found in such data leak incidents. Most of them had more than 10 million downloads on the Google Play Store and iOS App Store and their listings haven’t been pulled yet.
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https://ehrintelligence.com/news/small-hospitals-lack-financial-resources-for-ehr-optimization
Small Hospitals Lack Financial Resources for EHR Optimization
In a recent study, researchers found a direct correlation between EHR optimization and practice size, which ultimately affects clinical care quality.
July 20, 2020 - Progress of the HITECH Act’s meaningful use program has led to an increase in EHR optimization and improved patient care. However, rapid EHR optimization and health IT advancement takes up a considerable amount of resources, which results in a disparity between larger and smaller health facilities, according to a study published in the Public Library of Science (PLOS ONE).
Smaller hospitals have always had a disadvantage when it comes to EHR implementation and interoperability, largely because they have fewer resources than larger hospitals. In order for small hospitals to stay afloat, there are targeted approaches aimed to help smaller hospitals pay for EHR optimization, clinical decision support, and other health IT improvements.
“Studies have demonstrated a positive association between MU (meaningful use) implementation and improved process quality metrics in preventive screening, diabetes control, maternal and child health measures in primary care clinics that leveraged health IT for patient engagement and care coordination,” wrote the study authors.
In order to help standardize the monitoring of clinical quality performance, the Health Resources and Services Administration (HRSA) collects and analyzes data on electronically specified clinical quality measures (eCQMs) every year. Underserved hospitals that are funded by HRSA gain affordable and accessible healthcare.
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Frost & Sullivan analysis calls 2020 ‘an unforgiving but transformational year’ for healthcare
As the world contends with the crisis caused by the COVID-19 pandemic, the healthcare industry is expected to see a significant drop in growth.
By Sara Mageit
July 17, 2020 04:53 AM
Frost & Sullivan’s recent analysis, Post-Pandemic Global Healthcare Market Outlook, 2020 has been launched as part of its global Transformational Health Growth Partnership Service program.
The analysis forecasts that 2020 will be an ‘unforgiving but transformational year,’ and shows that post COVID-19, the healthcare industry is expected to witness a drop in growth from 5.3% to 0.6% in 2020, with revenues remaining below the $2 trillion mark.
WHY IT MATTERS
In light of the lessons learned from the pandemic and the changing economic scenario, Frost & Sullivan has re-visited predictions, identified top growth opportunities, and analysed risk-mitigation measures adopted by companies to survive the remainder of 2020, including:
- Reimbursement, training physicians, and platform scalability will be the key to recalibrating telehealth.
- Scale-up in capacity, flexible payment options, and redistribution of the workload will accelerate partnerships.
- To assist with the uneven distribution of ventilators across regions, Resmed has launched a remote monitoring solution for ventilators in the US and Europe through its cloud-based AirView platform for homecare.
- With alternate testing sites like pharmacies becoming permanent ecosystem participants, CVS and Walgreens have begun building the infrastructure to offer IVD testing at their locations.
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Meaningful digital health engagement is more complicated than how long or often users log in
A new study conducted among SilverCloud Health program users employed machine learning to identify relationships between app-use frequency and clinical outcomes.
By Dave Muoio
July 20, 2020 12:05 pm
Sustained engagement is a key metric when determining whether a digital health-based intervention is finding its mark, but the industry has been anything but uniform in determining objective measures of user behavior and their relationship to clinical outcomes.
A study published Friday in JAMA Network Open takes another approach and employs machine learning techniques to better describe engagement among 54,604 patients provided a digital health intervention – in this case, an internet-based cognitive behavioral therapy (iCBT) tool for depression and anxiety symptoms developed by SilverCloud Health.
"We used machine learning to build a probabilistic graphical modeling framework to understand longitudinal patterns of engagement with iCBT," the study's authors, which included researchers from Microsoft Research Cambridge and SilverCloud Health, wrote. "We hypothesized that these patterns would allow us to infer distinct, heterogeneous patient behavior subtypes. We further hypothesized that these subtypes are associated with the intervention’s success of improving mental health and that different subtypes of engagement are associated with differences in clinical outcomes."
The researchers' cohort comprised of de-identified patient data collected between January 31, 2015 and March 31, 2019 from SilverCloud's Space From Depression and Anxiety treatment program. This intervention included digital journals, quizzes, CBT exercises and live human guidance.
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More than 100 industry groups ask Trump to reverse HHS data reporting requirement
The public health, research, medical, science and legal organizations all voiced concerns about data availability and transparency under the new process, which instructs hospitals to bypass the CDC and report directly to HHS.
By Kat Jercich
July 20, 2020 04:31 PM
More than 100 public health, research, medical, science and legal organizations signed a letter Friday asking the Trump administration to reverse a new policy directing hospitals to report COVID-19 patient data to the U.S. Department of Health and Human Services.
HHS claimed in a press call on Wednesday that the new requirement was put in place with the support of the Centers for Disease Control and Prevention.
But experts voiced concerns that the controversial new practice represented a sidelining of public health policy in favor of politics.
"The administration’s abrupt decision to establish a new data collection procedure that bypasses the CDC as a recipient of data on patients hospitalized with COVID19 is alarming and will undermine efforts to control the pandemic at a time when COVID-19 cases and hospitalizations are surging across the country," wrote the stakeholders in Friday's letter.
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We Mapped the Human Genome 20 Years Ago. With More Sequencing Power, What Can We Do Next?
July 20, 2020
The following is a guest article by Josh Gluck, VP for Global Healthcare Technology Strategy at Pure Storage.
The world’s scientific community continues to break records. In the fight against COVID-19, the ability to leverage massive information sharing is leading to a more accurate picture of the disease and accelerating the development and testing of candidates for therapeutics and ultimately a vaccine.
Today’s work on COVID-19 is not unlike the world’s largest collaborative biological endeavor two decades ago: The Human Genome Project, which mapped all the genes in the human body from a physical and functional perspective. In the summer of 2000, we reached an important milestone in this epic initiative with the announcement of the first rough draft of the genome. Several factors led to this success, including developments in the field of genomics and major advances in computing technology. While the project had just 6 percent of the genome sequenced in 1998, a rapid acceleration in sequencing capabilities allowed researchers to sequence 90 percent of the genome in less than two years.
The Human Genome Project opened the door to personalized medicine as we know it – from genetic testing to targeted cancer treatments. Its first step was gathering data to assemble what the genome looks like – just getting the data and mapping it. But personalized medicine is still very much in its youth; we are just scratching the surface of its ability to yield advanced treatments – and even cures – for some of the world’s most serious diseases and conditions. Part of the challenge in accelerating personalized medicine is the need for even greater volume and diversity of data.
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https://www.healthcareittoday.com/2020/07/20/the-benefits-of-building-ehrs-around-care-plans/
The Benefits Of Building EHRs Around Care Plans
July 20, 2020
A former health system leader has laid out an interesting argument for refocusing EHRs on supporting care plans rather than simply documenting what care has been provided. Of course, there still seems to be considerable resistance to moving completely away from their original focus on billing, but that doesn’t mean we shouldn’t hope!
In this case, we have some worthwhile recommendations from John Glaser, a lecturer at the University of Pennsylvania, former CIO of Partners Healthcare, and formerly at Siemens/Cerner. In a recent piece for the Harvard Business Review, he explains why providers need a new breed of EHR, one which would “transition from an emphasis on a person’s medical record to an emphasis on a person’s plan for health.” Sounds a bit like the Care Pathways that Lumeon uses.
This new “plan-centric” EHR would offer several tools and options which are not available on current EHR systems, including:
- A rich library of care plans designed to address individual patient challenges, with the capacity to say, offer a different plan to a diabetic whose illness was well-managed than one supporting a patient still working to control their condition.
- Algorithms which dig into the range of issues patients may face (such as a mix of asthma, depression and obesity) and automatically develop a master plan for these patients
- Tools making these plans and to-do lists available to all members of the patient’s care team
- Support for having the plan travel across all of the care settings, geographical locations and EHRs a patient may encounter
- Decision support tools and workflow logic which remind care team members of upcoming and overdue activities, suggest changes in the plan when needed and routes messages to the appropriate team member
- Analytics for both individual patients and populations which assess how well the plan is meeting its pop health goals
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Physician Fatigue Linked to Electronic Health Record Use
By Christopher Cheney | July 20, 2020
New research provides more evidence that electronic health record use contributes to physician burnout.
KEY TAKEAWAYS
· Many physicians have expressed dissatisfaction with click-intense and data-busy electronic health record interfaces.
· Recent research examined physician fatigue while clinicians reviewed four simulated ICU cases in the Epic electronic health record.
· After conducting the simulated case reviews for 22 minutes, 80% of the participating physicians experienced fatigue.
Most physicians experience fatigue working with electronic health records (EHRs) for as little as 22 minutes, a recent research article indicates.
EHR use has been directly linked to physician burnout. For years, physicians have complained about click-intense and data-busy EHR interfaces. Excessive EHR screen time has been associated with medical errors.
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Positioning Telehealth for the Future: 'Rear-View Mirror' Lessons From COVID-19
By PSQH | July 19, 2020
During the pandemic, the spotlight has turned to telehealth and its power to deliver healthcare while maintaining social distancing.
This article was originally published July 15, 2020 on PSQH by Peter Antall, MD
“We have the technology.” It’s a catchphrase from “The Six Million Dollar Man,” a TV show that filled children of the 1970s with the hope that they would one day live in a world where bionic humans weren’t just the stuff of science fiction. And while bionic implants are still an emerging but competitive market, we’re entering a time when the digital health advancements many of us once dreamed of, like virtual care, are transforming healthcare as we know it.
Now, those advancements are not only critical to our country’s defense against the coronavirus pandemic—both the current wave and the subsequent waves—but they’re also allowing us to reimagine how all healthcare is delivered.
During the pandemic, the spotlight has turned to telehealth and its power to deliver healthcare while maintaining social distancing. But as the World Health Organization warns of a second peak of coronavirus cases in the United States and a second wave of COVID-19 later this year, healthcare leaders must consider: How do we apply the rear-view mirror lessons from the first wave of the pandemic to our virtual response to consumers’ healthcare needs during the second wave?
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https://www.healthleadersmedia.com/innovation/pandemic-speeds-ehr-implementation
Pandemic Speeds Up EHR Implementation
By PSQH | July 18, 2020
"EHRs by their nature are designed to protect and keep patient data private and confidential," says Doug Cusick, CEO of TransformativeMed.
This article was originally published July 15, 2020 on PSQH by John Palmer
Editor’s note: The following Q&A resulted from a conversation PSQH had with Doug Cusick, CEO of TransformativeMed, a Seattle-based electronic health record (EHR) provider and consultancy.
In this discussion, Cusick talks about why it has taken EHRs so long to roll out their technology virtually and why it took a pandemic to make EHRs—and health systems that use them—more accessible and easier to use.
PSQH: What do you think are the greatest benefits to implementing an EHR system virtually? What exactly would a virtual system look like, and what are some of the biggest infrastructure upgrades that would be needed?
Doug Cusick: The greatest benefit to a virtual EHR implementation is the cost savings to an organization.
Consider a scenario where an organization can sign up for an EHR service via a website, provide some basic information about the organization and its users, and then immediately begin using the software after some basic tutorials. This is a low-impact, low-cost alternative to traditional “go-lives” that, at most, might require some local computer upgrades to have increased memory capacity. A virtual or cloud-based EHR should require no significant infrastructure upgrades for the purchasing organization due to the very nature of the EHR being virtual. Likewise, “plug-and-play” or app-based technologies are also now available to make EHRs function more efficiently, and many allow for quick installation, configuration, and deployment.
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https://histalk2.com/2020/07/17/weekender-7-17-20/
Weekly News Recap
- Congressional Democrats criticize HHS for issuing a no-bid, $10.2 million contract in April for developing a hospital bed and supply tracking database to TeleTracking Technologies, the Pittsburgh-based hospital equipment and bed tracking vendor.
- Cerner and Epic delay their return to campus.
- Athenahealth renames its Centricity product line to AthenaIDX.
- University of California Health uses de-identified patient data from its Epic system to create a database for COVID-19 treatment research.
- Fax machines are part of a broken data system that is impeding US coronavirus response.
- Amazon will conduct a health center pilot with primary care service provider Crossover Health.
- A KLAS report on pediatric practice ambulatory EHRs names PCC as the clear leader.
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Enjoy!
David.
