Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, October 03, 2020

Weekly Overseas Health IT Links – 03 October, 2020.

 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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https://mhealthintelligence.com/news/study-finds-underserved-communities-are-receptive-to-mhealth-tools

Study Finds Underserved Communities Are Receptive to mHealth Tools

A study launched by the Yale School of Medicine finds that underserved communities will use mHealth tools to gather data and participate in studies if those tools are well-designed and aided by community health outreach.

By Eric Wicklund

September 24, 2020 - A good mHealth platform can influence underserved communities to manage their health and participate in clinical studies, according to a new study by researchers at the Yale School of Medicine.

As reported in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, a program launched through Project Access-New Haven and the Yale Primary Care Center saw strong interest among participants in a connected health platform that collected their health information.

The platform – funneled through an mHealth app developed by Hugo Health – was specifically designed to address the needs of low-income residents who struggle to access healthcare. It featured both English and Spanish versions, and the program was shepherded by community health workers who were familiar with the communities and able to address social determinants of health, including digital literacy and distrust of the health system.

According to the study, led by Erica Spatz, MD, of the Yale School of Medicine’s Center for Outcomes research and Evaluation, participants “were interested in having access to their health records and were open to participating in research.” More specifically, many were comfortable sharing data collected on wearable devices like Fitbits and blood pressure cuffs, and they were interested in being the owner of their health records, having those records stored in one place and being able to access them on a mobile device such as a smartphone or tablet.

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https://www.healthcareittoday.com/2020/09/25/microsoft-to-integrate-epic-ehr-and-nuance-automated-documentation-with-teams-tool/

Microsoft to Integrate Epic EHR and Nuance Automated Documentation with Teams Tool

September 25, 2020

Anne Zieger

Microsoft has announced two deals leveraging its Teams tool which could cast a long shadow over the rapidly evolving telehealth sector.

The tech giant signed an agreement with Epic under which the EHR vendor would become the first such organization to use the Teams connector function. Using this tool, clinicians and patients will have the ability to initiate virtual visits or consults directly from within the Epic platform.

Microsoft has also struck a deal with clinical documentation vendor Nuance which brings automated documentation to telehealth consults. Under the terms of the deal, the Nuance Dragon Ambient eXperience (DAX) has been integrated into Microsoft Teams, from which physicians will be able to access the DAX tool.

As readers who know my work for Healthcare IT Today know, I seldom praise new products, as I believe hard-nosed cynicism is more valuable in a world replete with technology hype.

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https://ehrintelligence.com/news/microsoft-opens-video-chat-platform-for-telehealth-ehr-integration

Microsoft Opens Video Chat Platform for Telehealth EHR Integration

Microsoft Teams will soon be available to health systems on Epic Systems EHR, intending to simplify telehealth visits.

By Christopher Jason

September 23, 2020 - Microsoft announced it is integrating its video chat platform, Teams, into EHR systems to allow clinicians to conduct telehealth visits through their respective EHR platforms.

Accessed through the Microsoft 365 cloud, Teams platform enables chat, video, and voice communication between two or more users. When integrated into the EHR for telehealth, it would enable communication between provider and patient on a single workflow.

“Microsoft Teams is helping people be together, even when they are apart,” Satya Nadella, CEO of Microsoft, said in a recent earnings call. “It’s the only solution with meetings, calls, chat, content collaboration with Office, and business process workflows – in a secure, integrated user experience.”

“Our new Microsoft Cloud for Healthcare is helping providers schedule, manage, and conduct virtual visits using Teams and engage with patients using Dynamics 365,” Nadella continued. “In healthcare, there were more than 46 million Teams meetings this past month.”

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https://healthitsecurity.com/news/just-44-of-healthcare-providers-meet-nist-cybersecurity-standards

Just 44% of Healthcare Providers Meet NIST Cybersecurity Standards

CynergisTek data shows that despite a dramatic increase in healthcare data breaches, cybersecurity progress in the sector is regressing as just 44 percent meet NIST standards.

By Jessica Davis

September 23, 2020 - Only 44 percent of healthcare organizations, including hospitals and health systems, adhere to NIST cybersecurity framework standards, despite a drastic increase in healthcare data breaches in recent years, according to a recent report from security firm CynergisTek

For its this annual report, CynergisTek analysts examined about 300 assessments of providers across the sector for the last three years against the NIST Cybersecurity framework, such as physician practices, accountable care organizations (ACOs), and business associates. 

Researchers found that only scores for conformance with the HIPAA Security Rule improved from 2018, but just by 1 percent from 2018 to 2019 to 76 percent, compared to 70 percent in 2017. 

“While the NIST CSF continues to grow in adoption internationally and in the US across all sectors, including healthcare, healthcare conformance with the CSF continues to lag across all sectors,” researchers wrote. “This decline in overall conformance should be an alarming call to action for the industry, not just for IT and security leaders.” 

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https://www.healthcareitnews.com/news/cios-spill-beans-phrases-they-hate-hear

CIOs spill the beans on the phrases they hate to hear

From "outlawed" buzzwords to frustratingly defeatist attitudes, servers on the fritz to budgets in disarray, more than a dozen health IT pros tell us their least favorite turns of phrase.

By Kat Jercich

September 24, 2020 12:40 PM

It's been a stressful time, to say the least, for hospital chief information officers and other IT professionals across industry. The COVID-19 crisis has put immense pressure on the need to optimize systems and enable clinicians to provide patients care in the most efficient ways possible. 

Even as the pandemic has sped up some valuable innovations, it has also created a revenue crunch, with many hospital budgets facing enormous funding shortfalls as nonessential procedures go by the wayside – forcing IT leaders to be ever more creative in their strategic thinking.

Then there's the day-to-day business of server maintenance, budget meetings, cybersecurity challenges, staff management, remote work optimization and more, providing no shortage of opportunities for stressors.

Six years ago, Healthcare IT News asked CIOs from hospitals across the country about the words they hate hearing. The answers, many of them comical, ran the gamut: budget issues, clinician complaints, technology hiccups and interpersonal challenges. 

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https://www.healthcareittoday.com/2020/09/24/does-remote-patient-monitoring-improve-outcomes-new-study-underway-to-find-out/

Does Remote Patient Monitoring Improve Outcomes? New Study Underway to Find Out

September 24, 2020

Colin Hung

Telehealth is one of the hottest technologies at the moment. It is dominating healthcare headlines [1] and is the topic of many discussions we have had here at Healthcare IT Today. However, I do not believe that patients are clamoring for telehealth per se, but rather are demanding care when and where it is convenient (and safe) for them.

In this light, telehealth is just one of many technologies that help patients achieve the goal of receiving care outside the walls of traditional provider facilities. Another technology that isn’t getting as much attention, but that is also experiencing significant growth is remote patient monitoring (RPM).

Remote Patient Monitoring – in the shadows of telehealth

The American Heart Association defines RPM as follows:

Remote patient monitoring (RPM) can empower patients to better manage their health and participate in their health care. When used by clinicians, RPM can provide a more holistic view of a patient’s health over time, increase visibility into a patient’s adherence to a treatment, and enable timely intervention before a costly care episode. Clinicians can strengthen their relationships with, and improve the experience of, their patients by using the data sent to them via RPM to develop a personalized care plan and to engage in joint decision-making to foster better outcomes.

With this definition you could say that RPM is a subset of telehealth but when most people think telehealth, they think of remote visit capability which is not a core component of RPM. In fact, the goal of RPM is often to avoid having a visit with a physician – virtual or otherwise. RPM simply works in the background and this might be why RPM has so far remained in the shadows of telehealth.

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https://www.healthcareittoday.com/2020/09/24/digital-twins-in-healthcare-insights-from-atos-experts/

Digital Twins in Healthcare – Insights from Atos Experts

September 24, 2020

John Lynn

One of the coolest healthcare concepts I’ve heard about recently is called a digital twin.  For those not familiar with the term, it’s basically a virtual model of a process, product, or service.  By pairing the virtual and the physical worlds, you can more easily analyze data and monitor systems to stop problems before they even occur.  Plus, you can use it to develop new opportunities or event potentially plan for the future using simulations.  Needless to say, the concept is pretty wide ranging right now, but we’re starting to see some real life applications of digital twins in healthcare as various IoT sensors are rolled out in healthcare.

To get a better understanding of some of the early use cases for Digital Twins in healthcare, I sat down with Niels Thomsen, VP & Global Head of the Insight (IoT & AI) Practice, and David Sele, Consultant and Business Developer – IoT at Atos.  Along with talking about what a digital twin is and where it’s being used in healthcare, I also ask them about the process of creating a digital twin and what technology is used to create and test against the twin.  They also share some of the details of a successful digital twin use case in healthcare.

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https://healthitanalytics.com/news/predictive-analytics-model-can-determine-covid-19-outcomes

Predictive Analytics Model Can Determine COVID-19 Outcomes

A predictive analytics tool uses demographic and clinical data to help hospitals determine COVID-19 outcomes and progression among patients.

By Jessica Kent

September 23, 2020 - Using a predictive analytics model, providers can better project COVID-19 outcomes for improved decision-making and resource allocation, according to a study published in Annals of Internal Medicine.

Researchers from Johns Hopkins University School of Medicine studied data from COVID-19 patients admitted to five Johns Hopkins hospitals between March 4 and April 24, 2020. During that period, Johns Hopkins admitted a combined 827 people aged 18 or older who tested positive for coronavirus and presented with symptoms of the virus.

Using data from these patients, as well as a set of risk factors known to be associated with COVID-19, to develop a predictive analytics model that could forecast how likely a patient’s disease is to worsen while in the hospital. Among the risk factors included were a patient’s age, body mass index (BMI), lung health and chronic disease, vital signs, and the severity of a patient’s symptoms at the time of admission.

The model, called the COVID Inpatient Risk Calculator (CIRC), can help providers assess the risk of a patient’s condition worsening.

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https://patientengagementhit.com/features/was-covid-19-healthcares-use-case-for-the-patient-portal

Was COVID-19 Healthcare’s Use Case for the Patient Portal?

The patient portal hadn't exactly yielded strong patient use. That was, until COVID-19 came. The pandemic has served as a key use case for the patient portal in care management.

September 18, 2020 - When it comes to patient engagement technology, the patient portal is somewhat like an umbrella. You might not use it very often, but when it rains — or when COVID-19 comes to the United States — you’re sure glad you have it.

“It's like you're out on a walk and it starts to drizzle, and you realize, ‘oh wait, I've got an umbrella in my bag,’” said Chris Mast, MD, vice president of Clinical Informatics at Epic Systems. “You kind of knew it was there, and it was something that you've used before, but all of a sudden, you really need it.”

That was the case for clinicians and patients alike at the start of the pandemic. People pulled this tool from their back pockets and were able to meet an unprecedented moment in healthcare.

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https://patientengagementhit.com/news/what-are-the-top-factors-leading-to-covid-19-health-disparities

What Are the Top Factors Leading to COVID-19 Health Disparities?

As healthcare learns more about racial health disparities related to COVID-19, it is incumbent upon providers to create action plans to drive equity.

By Sara Heath

September 22, 2020 - It did not take long for COVID-19 to prove that it would affect certain patient populations more than others. Within weeks of the virus coming ashore in the United States, health disparities, especially ones tied to race and ethnicity, became all too clear.

Early on in the pandemic, Centers for Disease Control & Prevention (CDC) data showed higher rates of COVID-19 infection among Black, Hispanic, and American Indian/Alaska Native (AI/AN) than compared to White patients. Anecdotally, neighborhoods and cities home to a higher population of Black and Hispanic people were harder hit by the virus than suburbs with larger populations of White patients.

By the middle of June, an assessment from the Brookings Institute revealed that racial health disparities may have been worse than previously thought. The analysis showed that Black and Hispanic patients were getting equally as sick as their white counterparts in the age bracket above them. In other words, Black and Hispanic patients were experiencing symptoms typical of someone much older than them.

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https://ehrintelligence.com/news/clinical-decision-support-in-the-ehr-cuts-healthcare-costs

Clinical Decision Support in the EHR Cuts Healthcare Costs

Health systems are saving money after implementing CDS alerts into their respective EHR systems.

By Christopher Jason

September 21, 2020 - EHR-based clinical decision support (CDS) interventions have an overall positive economic impact on health systems, according to a study published in the US National Library of Medicine.

While researchers noted a lack of extensive cost components in their analysis, researchers acknowledged CDS interventions had a positive economic impact on health systems, such as reducing healthcare waste.

CDS tools enable prescribers to access real-time patient data, ideally resulting in enhanced patient safety and medication accuracy. CDS alerts can also prevent errors and additional adverse drug events from happening. Implementing CDS alerts into EHRs aims to reduce costs based on these typical health system challenges.

In a literature review of 27 studies, researchers aimed to evaluate the economic impact of CDS interventions based on EHRs. Researchers also identified and categorized CDS best practices.

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https://ehrintelligence.com/news/how-covid-19-accelerated-the-digital-transformation-of-healthcare

How COVID-19 Accelerated the Digital Transformation of Healthcare

Transformation, innovation, and connection are three main healthcare principals that have been put under a microscope during COVID-19.

By Christopher Jason

September 22, 2020 - At the onset of the COVID-19 pandemic, three things were top-of-mind for Surescripts’ CEO, Tom Skelton: employee safety, ensuring the network remained operational, and adapting strategies to the evolution of technology. Because if there was one thing he knew for sure, it was the country wouldn’t come out of the pandemic thinking about healthcare the same way.

“Everything that we've done since then, from the way that we work, to the way we interact to the tools that we're making available to the market, have all been based on one of those three pillars,” Skelton said in an interview with EHRIntelligence.

“It started in February when it was pretty clear that this was getting serious and we haven't been together since then, which is now over six months, and we don't see that this is going to change a lot here in the next few months either.”

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https://www.fiercehealthcare.com/tech/microsoft-makes-big-play-for-healthcare-cloud-business-competition-google-amazon

Microsoft makes big play for healthcare cloud business in competition with Google, Amazon

by Heather Landi

Sep 23, 2020 12:27pm

Microsoft's new cloud service designed specifically for healthcare will be generally available October 30, the tech giant anounced Tuesday.

The Microsoft Cloud for Healthcare service bring together existing services such as Teams, Azure IoT and chatbots to help healthcare organizations manage operations.

Microsoft, Google and Amazon Web Services (AWS) are all pushing deeper into healthcare in a battle to provide cloud computing and data storage technology to hospitals.

Microsoft announced its first industry-specific cloud service back in May as part of a public preview.

The capabilities offered through the healthcare cloud service helps organizations scale up digital health technologies while also providing tools to improve data interoperability, workflow efficiency, and streamline interactions, the company said. 

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https://www.fiercehealthcare.com/tech/walmart-piloting-drone-delivery-for-covid-19-self-swab-kits

Walmart piloting drone delivery for COVID-19 self-swab kits

by Paige Minemyer 

Sep 22, 2020 1:36pm

Walmart is piloting drone delivery of home sample collection kits for COVID-19 in partnership with Quest Diagnostics.

The retail giant has been testing several uses for drone delivery under the pandemic, using them to bring customers grocery items and necessary health and wellness supplies. The testing kit pilot will begin in Las Vegas and Cheektowaga, New York, starting in early October.

Customers eligible for the drone delivery must live in single-family homes within a one-mile radius of Walmart stores in the two pilot regions, Walmart said.

The kits will be delivered in a customer's driveway, front sidewalk or backyard, depending on where there are cars or trees, Walmart said.

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https://www.statnews.com/2020/09/23/regina-barzilay-mit-artificial-intelligence-award/

When AI is the opposite of sinister: An MIT researcher is held up as model of how algorithms can benefit humanity

By Rebecca Robbins

September 23, 2020

In June, when MIT artificial intelligence researcher Regina Barzilay went to Massachusetts General Hospital for a mammogram, her data were run through a deep learning model designed to assess her risk of developing breast cancer, which she had been diagnosed with once before.

The workings of the algorithm, which predicted that her risk was low, were familiar: Barzilay helped build that very model, after being spurred by her 2014 cancer diagnosis to pivot her research to health care.

Barzilay’s work in AI, which ranges from tools for early cancer detection to platforms to identify new antibiotics, is increasingly garnering recognition: On Wednesday, the Association for the Advancement of Artificial Intelligence named Barzilay as the inaugural recipient of a new annual award honoring an individual developing or promoting AI for the good of society. The award comes with a $1 million prize sponsored by the Chinese education technology company Squirrel AI Learning.

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https://www.medpagetoday.com/patientcenteredmedicalhome/patientcenteredmedicalhome/88732

Writing What We Mean, and Meaning What We Write

— Today's electronic medical records require many words, but they're not all meaningful

by Fred N. Pelzman, MD September 21, 2020

There's an old adage in medicine that says, "If you don't write it, it didn't happen."

The saying grew out of the world of charting in the medical record, and the ability for that document to stand up under scrutiny during possible future legal proceedings. If not for that need, I think that our documentation would be much better, a much more realistic, truthful, and thoughtful thing that would really help us communicate and take better care of our patients.

"We Can Believe Nothing"

I recall a case I heard about many years ago, in the days when during depositions, the lawyers would enlarge every page of the medical record onto huge cardboard posters, and review every word written in the chart. A bad outcome had occurred on the inpatient service, and everybody who had even remotely touched the case was called in to give a deposition.

When it was the intern's turn, the lawyers went through every single line of each of the daily progress notes written by the intern throughout the entire hospital stay. At one point, the lawyer asked the intern to explain the documentation that was written for the physical exam in their daily progress notes. More specifically, the lawyer asked the intern to explain what "no clubbing/cyanosis/edema" meant.

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https://www.healthcareitnews.com/news/europe/uae-s-medcare-hospitals-adopt-trakcare-healthcare-information-system

UAE’s Medcare Hospitals to adopt TrakCare healthcare information system

The solution, which will be implemented across all of Medcare’s hospitals and clinics in Dubai and Sharjah, is owned by US technology company, InterSystems.

By Ahmed El Sherif

September 23, 2020 02:17 AM

The UAE’s Medcare Hospitals is to implement a unified healthcare information system (HIS) across its locations in Dubai and Sharjah, it has been confirmed. This follows an agreement with the US-headquartered software systems and technology company, InterSystems.

Medcare – a premium private healthcare provider and part of parent group, Aster DM Healthcare – will employ InterSystems’ TrakCare HIS in its four hospitals and 15 medical centres.

According to InterSystems, TrakCare provides “clinical, administrative, and financial information as a single source” for each patient in a single electronic patient record.

“TrakCare’s clear presentation of clinically relevant information, powerful clinical decision-support capabilities, and insightful analytics and reporting enable its users to make informed decisions quickly. Shared workflows enhance communication and enable seamless care-team collaboration,” it states on its website.

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https://www.healthcareitnews.com/news/europe/concerns-raised-about-transparency-nhs-covid-19-tracing-app

Concerns raised about transparency of NHS COVID-19 tracing app

Health charity calls for results of trials to be released, amid fears app could exacerbate inequalities.

By Tammy Lovell

September 23, 2020 08:59 AM

UK charity, the Health Foundation has called for greater transparency around the COVID-19 contact tracing app, which is set to be launched across England and Wales tomorrow.

It has raised concerns that the government has not revealed results of recent trials, which took place in the Isle of Wight and the London Borough of Newham.

The original NHSX app, which was designed to collect data in a centralised database, was abandoned after privacy concerns and a poor success rate in tracking proximity to other devices.

A redesigned version, which uses Google and Apple’s technology, works via Bluetooth to detect other smartphones nearby without using location data or sharing personal information. 

Features of the new app include allowing users to scan QR codes to register visits to hospitality venues, check and report symptoms, book testing, find out test results and check local risk levels.

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https://www.healthcareitnews.com/news/nurses-feeling-burnout-symptoms-ehrs-not-major-factor-says-klas

Nurses feeling burnout symptoms, but EHRs not a major factor, says KLAS

In its Nurse Burnout 2020 report, KLAS’ provider-led Arch Collaborative finds that one in four nurses are feeling stress and exhaustion – but shows that time-consuming tasks and lack of teamwork are more to blame than IT challenges.

By Bill Siwicki

September 23, 2020 11:33 AM

Nearly one in four nurses (24.6%) report symptoms of burnout, according to a survey of 37,440 U.S. nurses in new research from the Arch Collaborative, a KLAS initiative.

These nurses agreed with one or more of the following three statements: they are definitely burning out and have one or more symptoms of burnout (for example, emotional exhaustion); their symptoms will not go away and they are thinking about work frustrations a lot; or they feel completely burned out and are at the point where they may need to seek help.

The vast majority are OK

Meanwhile, three in four (75.4%) of the nurses surveyed for the report, Nurse Burnout 2020, say they’re not feeling burned out, the research showed. These nurses agreed with one or both of the following two statements: they enjoy their work and have no symptoms of burnout; or they are under stress and do not always have as much energy as they did, but do not feel burned out.

The Arch Collaborative focuses a lot of its work on EHRs. There is a slight, negative relationship between EHR satisfaction and nurse burnout, suggesting that as nurses become burned out their EHR satisfaction declines.

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https://www.healthcareitnews.com/news/new-health-it-discipline-social-informatics

A new health IT discipline: social informatics

Researchers at UCSF describe the emergence of a new field dedicated to better integrating and supporting the clinical use of social determinants of health data.

By Mike Miliard

September 23, 2020 01:21 PM

As the pandemic shines a harsh light on healthcare disparities – with COVID-19 affecting poor, minority and underserved communities to a significantly disproportionate degree – more attention has been focused on social determinants of health, and how health systems and community groups can better address them to keep these people safe and healthy.

But a major challenge with SDOH information, as has been long documented, appears in the difficulties with managing these different data types and integrating them into clinical care.

In a new article in the Journal of the American Medical Informatics Association, "A Call for Social Informatics," researchers from the University of California, San Francisco describe the challenges and opportunities for a proposed new discipline of health data innovation, and show how it can be formalized into a new domain of study.

Various medical organizations – American Academy of Family Physicians and the National Association of Community Health Centers to name just two – have come out in favor screening patients for SDOH. And federal agencies such as the Office of the National Coordinator for Health IT have thrown their support behind efforts to boost technology systems' ability to integrate SDOH data.

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https://www.healthcareittoday.com/2020/09/23/a-cios-guide-to-secure-bulk-emailing-healthcare-employees/

A CIOs Guide to Secure Bulk Emailing Healthcare Employees

September 23, 2020

Mitch Parker, CISO

A CIOs Guide to Secure Bulk Emailing Healthcare EmployeesA CIOs Guide to Secure Bulk Emailing Healthcare Employees

With the continued pervasiveness of remote work, team member engagement is more important than ever.  One of the ways to reach out to a lot of team members at once is email.  Team members, now more than ever, are empowered to use cloud-based or third-party services to send these messages.  The problem is that many of them don’t make it to the intended mailbox and end up in Junk Mail, never to return.  Worse, the emails can be spoofed, and ransomware or malware deployed instead.  The intended messages don’t get across, and in many cases, the feedback they seek is not collected.  This is why a number of email campaigns, even from major companies, advise their users to check their Junk Mail.  When you ask users to do that, what’s the point of filtering?

Today’s article is meant to change that.  Email is complicated because of the rules you have to follow to get it right, and attackers use that and our lowered attention spans to their advantage.  We’re going to lay out what processes you need to have and how to message it so you can do a better job of leading a strategic technology organization, not answering questions on why an important email ended up as junk mail.  We also want you to not have to answer the question of how that ransomware got in, ransacked the network, and was used to exfiltrate patient data.

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https://ehrintelligence.com/news/top-ehr-implementations-of-2020-so-far

Top EHR Implementations of 2020, So Far

From remote, virtual EHR implementations, to giant health systems transitioning away to other EHR vendors, 2020 has sparked a bevy of major EHR implementations.

By Christopher Jason

September 18, 2020 - When the novel coronavirus began its spread across the United States, it transformed healthcare in its entirety. That includes the health IT sector, where EHR vendors had to brainstorm and develop new EHR implementation ideas.

As a result, a number of remote, virtual EHR implementations launched, while another occurred at a pop-up hospital in the heart of New York City.

Meanwhile, in pre-pandemic days, wave of hospitals migrating away from certain revenue cycle products instigated large-scale EHR replacement projects. These stories represented some of the first transitions across EHR products wielding significant marketshare.

Although these are not all of the EHR implementations of 2020, these are some of the larger and most creative launches that’ll forever influence the industry. EHRIntelligence has listed these implementations in chronological order.

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https://www.helpnetsecurity.com/2020/09/21/5-simple-steps-to-bring-cyber-threat-intelligence-sharing-to-your-organization/

Chad Anderson, Senior Security Researcher, DomainTools

September 21, 2020

5 simple steps to bring cyber threat intelligence sharing to your organization

Cyber threat intelligence (CTI) sharing is a critical tool for security analysts. It takes the learnings from a single organization and shares it across the industry to strengthen the security practices of all.

By sharing CTI, security teams can alert each other to new findings across the threat landscape and flag active cybercrime campaigns and indicators of compromise (IOCs) that the cybersecurity community should be immediately aware of. As this intel spreads, organizations can work together to build upon each other’s defenses to combat the latest threat. This creates a herd-like immunity for networks as defensive capabilities are collectively raised.

Blue teams need to act more like red teams

A recent survey by Exabeam showed that 62 percent of blue teams have difficulty stopping red teams during adversary simulation exercises. A blue team is charged with defending one network. They have the benefit of knowing the ins and outs of their network better than any red team or cybercriminal, so they are well-equipped to spot abnormalities and IOCs and act fast to mitigate threats.

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https://www.healthcareitnews.com/news/hidden-plain-sight-clinicians-may-not-spot-ehr-cancer-risk-info

Hidden in plain sight: Clinicians may not spot EHR cancer risk info

A new study in the Journal of the American Medical Informatics Association found some patients' EHRs did not show a referral for genetic risk evaluations, although they met the national guidelines for one.

By Kat Jercich

September 21, 2020 03:03 PM

A new study in the Journal of the American Medical Informatics Association found that patients may have risk factors for heritable breast and ovarian cancers present throughout their electronic health records – but because the information is scattered, treating clinicians may not recognize it as actionable.

"The full story of a patient’s risk for heritable cancer within their record often does not exist in a single location. It is fragmented across entries created by many authors, over many years, in many locations and formats, and commonly from many different institutions in which women have received care over their lifetimes," wrote the research team from the University of Washington School of Medicine.

In their study of EHRs from 299 women, the team found that 8% met national guidelines for a referral for a genetic risk evaluation, but half of those patients had not been referred.

"Had the scattered risk factors for each patient been presented together to a treating provider with knowledge of NCCN guidelines, more women might have been referred to a medical geneticist or genetic counselor, and might have engaged appropriately in a discussion of the risks and benefits of genetic testing," wrote the researchers.

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https://ehrintelligence.com/news/clinical-decision-support-in-the-ehr-cuts-healthcare-costs

Clinical Decision Support in the EHR Cuts Healthcare Costs

Health systems are saving money after implementing CDS alerts into their respective EHR systems.

By Christopher Jason

September 21, 2020 - EHR-based clinical decision support (CDS) interventions have an overall positive economic impact on health systems, according to a study published in the US National Library of Medicine.

While researchers noted a lack of extensive cost components in their analysis, researchers acknowledged CDS interventions had a positive economic impact on health systems, such as reducing healthcare waste.

CDS tools enable prescribers to access real-time patient data, ideally resulting in enhanced patient safety and medication accuracy. CDS alerts can also prevent errors and additional adverse drug events from happening. Implementing CDS alerts into EHRs aims to reduce costs based on these typical health system challenges.

In a literature review of 27 studies, researchers aimed to evaluate the economic impact of CDS interventions based on EHRs. Researchers also identified and categorized CDS best practices.

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https://www.fda.gov/news-events/press-announcements/fda-launches-digital-health-center-excellence

FDA Launches the Digital Health Center of Excellence

For Immediate Release:

September 22, 2020

Today, the U.S. Food and Drug Administration announced it is launching the Digital Health Center of Excellence within the Center for Devices and Radiological Health (CDRH). The launch of the Digital Health Center of Excellence is an important step in furthering the agency’s overarching dedication to the advancement of digital health technology, including mobile health devices, Software as a Medical Device (SaMD), wearables when used as a medical device, and technologies used to study medical products.

“Establishing the Digital Health Center of Excellence is part of the FDA’s work to ensure that the most cutting-edge digital health technologies are rapidly developed and reviewed in the U.S.,” said FDA Commissioner Stephen M. Hahn, M.D. “Today’s announcement marks the next stage in applying a comprehensive approach to digital health technology to realize its full potential to empower consumers to make better-informed decisions about their own health and provide new options for facilitating prevention, early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional care settings. The Digital Health Center of Excellence will provide centralized expertise and serve as a resource for digital health technologies and policy for digital health innovators, the public, and FDA staff.”

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https://www.healthcareitnews.com/blog/terminology-standards-bridging-gaps-between-health-systems-during-covid-19

Terminology standards bridging gaps between health systems during COVID-19

Communicating lab orders and results across multiple care settings and with treating physicians, quickly and effectively, is the need of the hour.

By Joyoti Goswami

September 22, 2020 02:01 PM

The clinical manifestations of COVID-19 are varied, and patients are known to have rapidly changing signs and symptoms that must be tracked with laboratory testing. A patient may start his treatment journey with his primary care physician and will include lab centers, diagnostic centers, inpatient, and home quarantine centers. 

It is crucial for the respective laboratory information or electronic health record systems to share the lab tests and diagnostic information with each other. Communicating the lab orders and results across multiple care settings and with treating physicians, quickly and effectively, is the need of the hour.  

A patient encounter creates observational data such as vital signs, symptoms, diagnoses, and diagnostic information, along with prescription details. The observational data findings, and laboratory and diagnostic information, along with medical knowledge and clinical guidelines, forms part of a clinical database. The data here can be turned into information only when systems use the right terminology standards. 

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https://www.healthcareitnews.com/news/asia-pacific/clinicians-singapore-develop-robot-faster-covid-19-nasal-swabbing

Clinicians in Singapore develop robot for faster COVID-19 nasal swabbing

SwabBot is a self-administered robot which allows individuals being swabbed to activate and terminate the swabbing process at will.

By Dean Koh

September 22, 2020 03:15 AM

A group of clinicians from the National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH) and Duke-NUS Medical School has partnered Biobot Surgical Pte Ltd, a local company which focuses on medical robotics solutions, to develop a robot that automates nasal swabbing needed to diagnose COVID-19. Nasal swab is the preferred method of gathering the specimen as it gives the best yield for processing by laboratory.

WHAT IT DOES

SwabBot is a self-administered robot which allows individuals being swabbed to activate and terminate the swabbing process at will. When ready, they use their chin to activate the robot and begin the swabbing process. The robot extends the swab safely and gently through the nose to the back of the nasal cavity, which is typically about 10cm from the nostrils.

To ensure the safety of the individual, the robot has a built-in feature, which retracts the swab stick if there is resistance when moving deeper into the nasal cavity. In the unlikely case that the individual is unable to tolerate the process, they can terminate it by moving their head away from the robot.

WHY IT MATTERS

The robot was born to help address the limitations of manual COVID-19 swabbing by reducing swabbers’ risk of exposure to the virus, reducing the need for trained manpower, standardizing the consistency of swabs taken and providing greater throughput of swab tests. This is because the robot does not get tired and remains efficient. The duration of the test is just 20 seconds from start to finish.

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https://www.healthcareitnews.com/news/europe/german-hospitals-get-3-billion-funding-boost-digitalisation

German hospitals to get €3 billion funding boost for digitalisation

The Hospital Future Act aims to modernise the country’s hospital system.

By Tammy Lovell

September 22, 2020 04:28 AM

German health minister Jens Spahn has announced €3 billion for hospitals to invest in modern emergency capacities, digitisation and IT security.

The funding for projects to modernise the hospital system will be provided under the hospital future fund (KHZF), from the health fund’s liquidity reserve. This will cover 70% of projects and 30% will be funded by the federal states/ hospital operators, which will raise a further €1.3 billion.

Projects eligible for funding are set out in the draft Hospital Future Act (KHZG), which was passed by the Bundestag on 18 September and is expected to come into force next month. They include patient portals, electronic documentation of care and treatment services, digital medication management, IT security measures and cross-sector telemedical network structures. The funding can also be used to introduce or improve telemedicine, robotics and high-tech medicine.

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https://www.healthcareittoday.com/2020/09/22/asparia-chatbot-integration-with-epic-yields-a-seamless-experience-for-patients-and-epic-users/

Asparia Chatbot Integration with Epic Yields a Seamless Experience for Patients and Epic Users

September 22, 2020

If I were to map out the phases of EMR, it would look like this:

  • EMR Adoption. Rapid EMR adoption and implementation fueled by the generous government incentive program (Meaningful Use)
  • EMR Consolidation. Providers either decided to switch to a different EMR or were forced to change due to the consolidation or shuttering of their original vendor
  • EMR Optimization. Organizations focused on improving the usability and effectiveness of their EMRs by adding customization, upgrades and training.

I believe most healthcare organizations are still in the Optimization phase, but a growing number are transitioning to the next phase, something I think of as:

  • EMR Extension. Using the EMR as a foundation for enhanced care. Adoption of new add-on modules and solutions that use the EMR as a platform to both source and store data.

This next phase continues the evolution and maturity of EMRs. With over a decade of continuous investment, healthcare organizations of all sizes are looking for ways to better leverage the data, workflows and connectivity that they have baked into their EMR systems.

Integration extends EMRs

To deliver enhanced care, tighter integration between EMRs and applications developed by innovative 3rd party vendors needs to be in place. This means EMRs need to become more open and easier to access.

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https://www.healthcareittoday.com/2020/09/22/health-systems-arent-doing-a-great-job-of-managing-provider-data/

Health Systems Aren’t Doing A Great Job Of Managing Provider Data

September 22, 2020

Anne Zieger

Particularly since the COVID-19 hurricane has hit the healthcare system, health systems are struggling to manage and validate even basic data on providers, according to a new research study looking at the impact of such inaccuracies on operational efficiency.

The healthcare business of LexisNexis Risk Solutions surveyed more than 100 providers across the industry, including independent hospitals, teaching hospitals, independent physician groups and federally qualified health centers to get a sense of how they were tackling the provider data problem.

While maintaining the integrity of data like provider addresses and phone numbers isn’t terribly sexy, it’s important, especially with the pandemic increasing the importance of smooth care coordination.  This is a particularly bad time to force providers to spend time, say, digging up an accurate fax number to send over a referral. However, despite spending an estimated $2 billion a year industry-wide to maintain this data, it’s usually riddled with errors.

According to LexisNexis, basic information organizations have on their providers – such as their location, specialty, contact information and availability – is often flawed. Common errors include unlisted office locations, incorrect contact details and inaccurate reports as to whether the provider accepts new patients.

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https://www.healthleadersmedia.com/innovation/how-healthcare-systems-can-sustain-digital-momentum-spurred-covid-19

How Healthcare Systems Can Sustain the Digital Momentum Spurred by COVID-19

By Mandy Roth  |   September 21, 2020

An Accenture digital health expert provides insights regarding why digital health stalled before the pandemic and how to keep the ball rolling now that it's been more broadly used by consumers and clinicians.


KEY TAKEAWAYS

·         Prior to COVID-19, fewer consumers were using digital health tools, but the pandemic forced adoption, accelerating usage and underscoring the benefits of technology.

·         Consumers are seeking information and guidance from clinicians about how to use digital tools; those who provide it can accelerate engagement.

·         As healthcare systems roll out digital solutions, they need to design for those who have access to technology and for those who don't.

Earlier this year, the health practice of the global consulting firm Accenture released its 2020 Digital Health Consumer Survey, which contained some fairly grim news regarding the use of digital health devices. Fewer consumers were using digital tools to manage their health, the study determined. The numbers were significant.

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https://mhealthintelligence.com/news/consortium-pushes-telehealth-freedoms-for-substance-abuse-treatment

Consortium Pushes Telehealth Freedoms for Substance Abuse Treatment

A new Health Affairs blog urges the federal government to continue telehealth waivers for substance abuse treatment during the COVID-19 emergency and asks for permanent changes to safeguards around the use of buprenorphine.

By Eric Wicklund

September 18, 2020 - A group of clinicians and public health experts is pressing the federal government to make permanent telehealth policy changes that would improve access to care for people undergoing substance abuse treatment.

In a recent blog in Health Affairs, the Buprenorphine Telehealth Consortium is urging the Health and Human Services Secretary to waive a requirement in the Ryan Haight Act that mandates an in-person exam for emergency treatment during the ongoing coronavirus pandemic. This would allow providers to use telehealth to determine whether a patient undergoing treatment for substance abuse and prescribe buprenorphine, an opioid medication used to treat addiction.

Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, certain healthcare providers were allowed to prescribe controlled substances for treatment as long as they’d first had an in-person examination with the patient. That law offered several instances in which the in-person requirement could be waived. On March 16, the US Drug Enforcement Agency (DEA) waived that requirement under by invoking the public health emergency exception.

The group is continuing an argument long supported by substance abuse care providers and telehealth advocates, who say providers should be able to conduct that initial in-person exam by telemedicine or even a phone, and also use the platform to prescribe medications. With substance abuse rates soaring across the country even before the current emergency, providers see connected health as a much-needed channel to expanding access to care.

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https://www.fiercehealthcare.com/tech/bigger-health-systems-aren-t-doing-a-better-job-at-cybersecurity-new-report-finds-here-s-why

Bigger health systems aren't doing a better job at cybersecurity, report finds. Here's why

by Heather Landi 

Sep 18, 2020 3:15pm

Only 44% of healthcare organizations, including hospitals, health systems and third-party vendors, are meeting national cybersecurity standards designed to protect against cyberattacks.

And bigger healthcare institutions with larger budgets didn't necessarily perform better when it comes to security, according to a new report from cybersecurity firm CynergisTek. In fact, big organizations sometimes performed worse than smaller organizations or those that invested less, the report found.

In some cases, this was a direct result of consolidation where systems directly connect to newly acquired hospitals without first shoring up their security posture and conducting a compromise assessment, according to CynergisTek.

Analysts at the Austin, Texas-based security firm examined nearly 300 assessments of provider facilities, including hospitals, physician practices, accountable care organizations and business associates, to determine how well they are conforming to the National Institute of Standards and Technology’s Cybersecurity Framework (NIST CSF) protocols, which are considered security best practices.

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https://www.healthcareitnews.com/news/asia-pacific/digital-engagement-and-transformation-healthcare-singapore

Asia Pacific

Government & Policy

Digital engagement and transformation of healthcare in Singapore

IHiS, Singapore’s national health IT agency aims to better digitally engage patients in a less transactional manner in the post pandemic era.

By Dean Koh

September 21, 2020 02:14 AM

COVID-19 has pushed digital health technologies such as telehealth and remote monitoring /virtual care into the fore, and the nation-state of Singapore is no exception. Its ‘whole of society’ approach to combating the pandemic, in which the government, private sector and citizens come together as a unit has resulted in an extremely low fatality rate of 0.05% (27 deaths out of more than 57,000 cases at the time of writing).

Another important component in Singapore’s effective approach in containing the pandemic is the Ministry of Health’s method of risk profiling through multi-agency efforts to capture data, and subsequently having tiers to provide different levels of care based on the COVID-19 patient cases’ severity.

Bruce Liang, CEO of Integrated Health Information Systems (IHiS), Singapore’s national health IT agency, said during the first episode of the Singapore Digital Dialogue Series that the use of tech, together with the close alignment of the Health Ministry’s risk stratification plans, has resulted in the adoption of a care model that is “manpower light and tech heavy”. With the majority of confirmed COVID-19 cases being relatively healthy, these patients can be managed with the use of remote monitoring tech in newly created Community Care Facilities (CCFs), while manpower can be focused on dealing with higher-risk patients.

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https://www.healthcareitnews.com/news/mayo-clinic-ai-and-ml-are-complementary-clinicians-skills-not-replacement

Mayo Clinic: AI and ML are 'complementary' to clinicians' skills, not a replacement

In a HIMSS Learning Center presentation, Mayo Clinic oncologists Dr. Tufia Haddad and Dr. Nadia Laack will share their perspectives about the potential for AI to accelerate clinical research and improve care.

By Kat Jercich

September 21, 2020 10:44 AM

The COVID-19 pandemic has dramatically altered the shape of healthcare around the country, including when it comes to priorities around incorporating artificial intelligence and machine learning into a system's landscape.

But the need for clinical research has not slackened amid the crisis. In fact, the pandemic demonstrates how solid foundational work to implement AI and ML into workflows can be beneficial – and even crucial – both for solving short-term, urgent issues and for planning longer-term strategies.

Experts at the Mayo Clinic say AI and ML are powerful tools for clinical research and care.

"Rather than thinking of AI/ML in medicine as 'man vs. machine,' we like to think of it as (wo)man with machine," said Dr. Tufia Haddad, a medical oncologist at the Mayo Clinic, in an interview with Healthcare IT News.

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https://mhealthintelligence.com/news/telehealth-task-force-announces-policy-change-recommendations

Telehealth Task Force Announces Policy Change Recommendations

A task force launched in June to study how telehealth has been used during the coronavirus pandemic has released a study and list of recommendations for expanding coverage after COVID-19.

By Eric Wicklund

September 16, 2020 - A task force comprised of some of the biggest names in telehealth advocacy has issued a report calling for permanent changes to telehealth coverage beyond the coronavirus pandemic.

The Taskforce on Telehealth Policy, launched in June by the American Telemedicine Association, Alliance for Connected Care and National Committee for Quality Assurance, unveiled the report this week as pressure ramps up on the federal government and Congress to keep certain connected health policies in place after the public health emergency ends.

“This report sets the stage for the clear, decisive action from policymakers,” ACC Executive Director Krista Drobac said in a press release issued after the Tuesday afternoon event. “While there is a need for continued data collection and thoughtful regulation, this report demonstrates that both patients and clinicians agree that remote care options should remain available after the public health emergency comes to an end.”

In its report, the task force argues that many of the restrictions on telehealth coverage and use were put in place when the technology was unproven, and there were questions about cost, value and overuse. But the surge in use of connected health services and tools to deal with the coronavirus pandemic has given the healthcare industry – and its regulators – plenty of data on how the technology can and should be used.

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https://healthitanalytics.com/features/applying-artificial-intelligence-to-chronic-disease-management

Applying Artificial Intelligence to Chronic Disease Management

Artificial intelligence tools can help providers navigate the complexities of chronic disease management, leading to more effective, quality treatments.

September 18, 2020 - When it comes to healthcare, it seems Americans spend more to receive less.

An aging population, expensive pharmaceuticals, and administrative waste result in sky-high medical costs, while health outcomes remain poorer than those in other high-income countries.

While many elements influence the country’s rising healthcare spending, the prevalence of chronic disease is perhaps the most significant factor at play.

Chronic diseases are the leading causes of death and disability in the US, as well as the main drivers of the country’s $3.5 trillion in annual health costs.

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https://histalk2.com/2020/09/18/weekender-9-18-20/

Weekly News Recap

  • Amwell raises $742 million in its IPO.
  • Provation acquires EPreop.
  • MDLive secures investment totalling $75 million.
  • Change Healthcare announces plans to permanently close its Nashville headquarters.
  • Amazon opens up its HIPAA-compliant Alexa skill program to interested app developers.
  • Apple adds a blood oxygen monitoring feature to the newest version of Apple Watch.
  • Kaiser Permanente launches Virtual Plus, a virtual-forward health plan for members in six Washington counties.

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Enjoy!

David.

Friday, October 02, 2020

It Seems That We Can’t Be Sure All Telehealth Is Really Safe At Present And More Work Is Needed In Multiple Areas.

This appeared a few days ago:

Telehealth triage 'not safe' for chest pain: study

Findings from a Dutch out-of-hours service shows phone triage underestimates the condition in more than one quarter of patients

22nd September 2020

By Carmel Sparke

GP out-of-hours phone triage systems for chest pain are neither safe nor efficient, a Dutch study suggests. 

The researchers found the system underestimated the urgency of chest pain in more than one quarter of patients whose pain later proved to be either acute coronary syndrome (ACS) or another life-threatening event.

The team from the Julius Centre for Health Sciences and Primary Care in Utrecht listened back to telephone conversations with more than 2000 patients who called the GP out-of-hours service between 2014 and 2016. 

They compared these with final diagnoses recorded in medical notes. 

Overall, 11% of patients who called with chest pain had ACS (men 15%, women 8%) and 3% had another life-threatening event. 

Of these, 27% had their chest pain rated as non-urgent. 

After nurses' gave their input this figure fell to 14% . 

“Primary care semi-automatic assisted telephone triage of patients with chest discomfort is not safe or efficient,” the researchers wrote in Open Heart


More information: Open Heart 2020; 21 Sept

More here:

https://www.ausdoc.com.au/news/telehealth-triage-not-safe-chest-pain-study

What this says to me is that as we see new models of remote care delivery being implemented we need to make sure we are carefully evaluating for both short and long term harms and risks.

Such wholesale changes in the way care is delivered are unlikely to be utterly free of side effects and we need to be really alert to them happening.

In another related issue we see that policy around telehealth may still need some tweaking.

Early medical abortion: telehealth restrictions discriminatory

Authored by Cate Swannell

Issue 37 / 21 September 2020

TELEHEALTH restrictions introduced by the federal Department of Health on 20 July 2020 discriminate against women seeking early medical abortion (EMA), making an already hard to access procedure even more out of reach.

Professor Danielle Mazza, Head of the Department of General Practice at Monash University, told InSight+ that telehealth offers an opportunity to address limited access to EMA during the COVID-19 pandemic and beyond.

“Telehealth is an amazing tool to increase equity of access because if you can’t get that service provided to you locally, you can get the service provided to you by another provider in a different geographical location,” Professor Mazza said.

“At the moment, 2317 GPs in Australia are currently registered prescribers of MS2Step (mifepristone and misoprostol), but we think far fewer actually go on to actively prescribe.

“Actually, setting up this service in your practice involves a number of other steps and having the confidence to do it, plus having the support of your colleagues in your practice, the front desk manager and the reception staff.

“So, you can do the course [in order to become a prescriber], but that doesn’t mean you’re actually going to deliver the service.”

“Telehealth therefore helps women to overcome that problem of not having a local provider in their region.”

With the advent of the COVID-19 pandemic the federal Department of Health introduced temporary Medicare Benefits Schedule (MBS) item numbers for telehealth GP consultations to enable patients to see their doctors in a contactless environment.

But since 20 July, new restrictions to those MBS item numbers have been implemented, namely restricting eligibility to only patients who have visited the GP or practice in the previous 12 months or those who have been referred by a specialist, except for where there is a current lockdown in place.

“The changes that were introduced on 20 July were trying to support continuity of care, and that’s a very important principle,” Professor Mazza said.

“I’m a GP. I understand the benefits of continuity of care, but you can’t have continuity of care if you don’t provide a service.”

In a Perspective published today by the MJA, Professor Mazza and colleagues wrote that the new restrictions “will greatly reduce women’s access to EMA”.

“Placing restrictions on the eligibility criteria for MBS-subsidised telehealth services severely affects women’s access to GPs who can provide EMA, and discriminates against women who have not recently engaged with a GP due to various forms of disadvantage, such as family violence and unemployment.

“Exemptions to the restrictions have already been identified for people who are homeless and for children aged less than 12 months.

“Therefore, a further exemption should also be issued so that registered prescribers of medical abortion are able to use MBS telehealth item numbers for the benefit of Australian women.”

Lots more here:

https://insightplus.mja.com.au/2020/37/early-medical-abortion-telehealth-restrictions-discriminatory/

All this reflects we need to keep a careful watching brief as the technology is rolled out. Wholesale change can never be assumed to be safe and free from the famous 'unintended consequences'.

David.