It is called the Draft National Healthcare Interoperability Plan – Oct 2021
It can be found here:
It is worth a read to see how little seems to have really changed and it really does not seem that anyone actually has a real plan to actually move forward. Lots of positive thoughts but no real funding and mechanisms for implementation I can see.
To me it is totally unclear just what is going to cause any of this to happen!
What do others think?
David.
This appeared last week:
Sunday, 28 November 2021
NEWS - eHealthNews.nz editor Rebecca McBeth
Lack of integration and IT systems that are not fit for purpose are highlighted in a report into the “potentially preventable” deaths of two people in home isolation after contracting Covid-19.
The Northern Region Health Coordination Centre (NRHCC) commissioned the report into the Community Supported Isolation and Quarantine (CIQ) system in consultation with the Ministry of Health after a man died at home in Auckland on November 3. A second person died on November 5.
An independent review panel found there were “missed opportunities” that contributed to the deaths and the IT systems supporting the home isolation of Covid-19 patients , “have suffered from being unable to be either linked or effectively reconfigured to meet the priority needs”.
Also, “escalation pathways did not occur or function as planned, either for unclear reasons or due to software design issues”, the report says.
It recommends considering a “virtual ward round” model for the highest risk patients isolating at home and the NRHCC says it has since launched a Hospital in the Home initiative across all three DHBs, for cases needing a lot of health support.
The report says connectivity between all parts of the system is essential and clinical, welfare and other information that informs risk should be visible by the whole system from a common source.
“Supporting IT systems must be rapidly made fit for purpose with a focus on assessing and meeting clinical and welfare risks and needs,” the report says, adding that IT systems must ensure Māori particularly are not further disadvantaged.
"There is an absence of connectivity between the organisations providing different care and assessment functions," it says, describing each agency as 'blind' to the information in the other agencies systems.
It recommends that health information held in the Northern Region’s Clinical Portal and in general practice clinical records should be accessible to the clinicians and other teams doing an initial assessment of Covid-19 patients and ongoing health checks when they are isolating at home.
“Clinical support decision making tools should be embedded in the systems being used for screening of both inbound and outbound calls,” the review panel recommends.
A clinical acuity assessment tool has been reviewed and endorsed by the regional Clinical Technical Advisory Group and the panel says it should be urgently implemented.
The report says the re-emergence of Covid-19 in Auckland in August 2021 made community self-isolation “imperative and urgent” and the rapid increase in patients needing the service far exceeded planning and expectations, leading to the service being overwhelmed.
The report says the emphasis on technologies such as SMS, home oximetry, video conferencing and website-based information links is challenging for some patients who may struggle to access it due to low health literacy and lack of data or connectivity.
More here:
https://www.hinz.org.nz/news/588283/IT-issues-highlighted-in-home-isolation-deaths.htm
There is also excellent coverage here:
Media release from the Northern Region Health Coordination Centre
Monday 29 November 2021, 11:31 AM
The Northern Region Health Coordination Centre (NRHCC) has committed to learn from an independent review into the deaths of two people who had tested positive for COVID-19 and were self-isolating at home.
The independent review panel released its findings today on two separate cases, the first is a person who was living in Manukau. and another in Mount Eden. Both were living alone at the time of their passing.
The review findings have been released following consultation with the whānau of the deceased, who have provided feedback that has been included in the report. This considers each case as well as the Community Supported Isolation and Quarantine (CIQ) system. The NRHCC has already made important changes.
The
Chair of the Review Panel, Dr Jonathan Christiansen, Chief Medical Officer,
Waitematā DHB, has summarised key findings of the report and its
recommendations including:
• The need for earlier assessment of clinical safety, welfare needs and mental
wellbeing of COVID-19 patients in Community Supported Isolation and Quarantine
(CIQ)
• Better connectivity between all parts of the system to ensure clinical
oversight
• Heightened focus on equity and cultural safety, specifically Māori and
Pasifika
• The need for stronger clinical governance for adequate reporting systems and
rapid informed review of adverse events
It also identified significant opportunities to rapidly strengthen the capability, safety, equity and patient focus of the CIQ system.
The panel also considered both deaths were potentially preventable and there were missed opportunities contributing to the outcome.
The report was initiated by the Northern Region Health Coordination Centre (NRHCC) in consultation with the Ministry of Health following the first death on 3 November 2021. The second death followed two days after.
Northern Region Health Coordination Centre Lead (and Counties Manukau Health CEO) Fepulea’l Margie Apa, responded to the report saying:
“It is a very sad time for both the whānau and friends of these two people and our hearts and thoughts are with them as they come to terms with their loss. We are fully committed to providing any support we can.
“People in healthcare work tirelessly to provide the best care possible, however, it is clear that more could have been done and needs to be done. The main lesson is the need for improvement, which is what we are all committed to achieve.
“We unreservedly accept the findings of the review and apologise to the whānau for the shortfalls in the response provided. We are grateful to whānau for providing input at such a difficult time. I want to acknowledge the steps that have already been taken to strengthen the approach and address the recommendations made.
“This has been a thorough but swift process, undertaken by independent experts. This was absolutely essential to ensure transparency and for people to understand what happened.
“These two deaths resulted from a combination of situations and events, and we needed to analyse them quickly so we can improve our care in the future. The model for CIQ we have in place now is not the end point, it is an interim back up while we support primary and community based teams to build their capability to look after their enrolled patients.”
The review report points out the CIQ system was established to meet the needs of a rapidly growing number of patients with COVID-19 and their whānau in a short space of time. It says that, given the speed of change and the complexity of the system, it is remarkable that much has gone well.
It also says there are significant opportunities now to rapidly strengthen the capability, safety, equity and patient focus on the CIQ system and the care pathway overall.
Changes have been made to CIQ in the last three weeks with clinicians, administrators, public health teams and community organisations working to stabilise and improve the system. Improvements made to date include:
o
The piloting of new models with Māori and Pacific providers who are able to
provide holistic clinical, social, welfare and mental wellbeing support
o Immediate clinical assessment using information already available to quickly
identify those who are high risk and needing special clinical, social or mental
health support
o Reduction of the time taken between a positive test and the first clinical
assessment
o The launch of a Hospital in the Home initiative across all three DHBs for
cases needing a lot of health support
o Door knocking for those not able to be contacted, particularly those
isolating alone
o The establishment of a CIQ Clinical Governance Group with the purpose of
identifying emerging risks and trends, so that issues can be addressed. The
Group has already met.
Margie
Apa continues:
“The report highlights a number of areas where improvements to the whole system
were needed. As with the rest of the world, we’re moving in a fast-paced
environment where we have to change our response as things evolve.
“Importantly, one of the key areas of improvement relates to the assessment of individual welfare needs and wellbeing, and there is extensive work happening across the health and social sectors, and with our Māori and Pacific communities, to support a strengthened response.
“We are managing an increasing number of positive COVID-19 cases in the community. What is clear is the serious nature of Delta and how it can affect people very quickly, especially those who are unvaccinated with pre-existing conditions. When it strikes, it can be swiftly devastating.
“This report provides valuable lessons for all New Zealanders who need to take this illness very seriously. Everyone should get vaccinated to give them maximum protection when they are exposed to the virus, and no one should dismiss symptoms or wait and see how it develops.
“Act immediately, get tested and stay at home until you get your result. If you become unwell call healthcare services or your GP, and if you have difficulty breathing or are very unwell call 111. All these services are free when COVID-19 is involved.
“Treat COVID-19 seriously and get help. Listen to the advice you are given. Be aware of your whānau and friends, and help them if needed. Most importantly, get vaccinated to reduce the risk of serious consequences from COVID-19.
“The CIQ system has been analysed in detail in this report. As a health system, a community and a nation, we all have a responsibility to look after each other as we continue to battle this pandemic.”
More here:
It is well known that, because of the large numbers, during COVID19 outbreaks may COVID positive patients with various levels of clinical impairment have been sent home with various forms of home monitoring (e.g. a pulse oximeter and some vitals assessment technology) and told to:
1. Measure and report in regularly.
2. Come to hospital quickly if the feel they are detiorating.
We also know that despite these precautions that all over the world there have been a number of unexpected and problematic deaths.
What this report adds is that there are a range of integration and information issues which may not be ideally handled – as well as issues which would be best described as some problems with the individual’s “social determinants of health” that can add to risk. Clearly health and technical literacy is a big one here!
There were, in this case, also issues of the services that were offered being easily scalable to meet demand.
I found this report a useful reminder of both the need to plan carefully as well as to adjust services that need improvement. This has been especially important in the COVID response globally!
David.
Here are the results of the poll.
Very Useful 0% (0)
Mildly Useful 7% (4)
Neutral 5% (3)
Not Useful 51% (30)
An Active Inhibitor 36% (21)
I Have No Idea 2% (1)
Total votes: 59
Overall it seems most thought the ADHA has not helped!
Any insights on the poll are welcome, as a comment, as usual!
A fair number of votes with a clear outcome!
1 of 59 who answered the poll admitted to not being sure about the answer to the question!
Again, many, many thanks to all those who voted!
David.
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.
-----
Following the announcement that NHS Digital and NHSX is to merge with NHS England and Improvement, Digital Health’s editor-in-chief, Jon Hoeksma, explores what the consequences will be for the NHS IT community.
John Hoeksma – 25 Nov, 2021
NHS Digital and NHSX staff deserve a lot of sympathy this week. Having worked tirelessly throughout the pandemic, their reward is to be told the axe is to fall on their organisations, with many facing uncertainty surrounding their jobs.
News of the axing of NHS Digital (6000 staff) and NHSX (around 900 staff and contractors), was sudden and was delivered via a staff announcement from NHS England and Improvement CEO, Amanda Pritchard.
While a rationalisation of the many duplicate roles and responsibilities was widely expected, the full-blown take-over of NHS Digital caught many by surprise.
By making NHS Digital its in-house tech team, NHS England and Improvement will almost doubles its 6,500 staff overnight, in the short-term at least. There is a strong suspicion that the sheer size of NHS England and Improvement could lead to more job cuts.
-----
The review of NHS IT organisations by Laura Wade-Gery has finally been published, and as exclusively revealed by Digital Health News, recommends the axing of NHS Digital and NHSX.
John Hoeksma – 24 Nov, 2021
Instead, the review says that NHS England and Improvement must take over responsibility for digital and data within the wider transformation agenda and embed it at all levels. The decision to implement the core recommendation was announced by NHS England and Improvement CEO, Amanda Pritchard, to staff on November 22.
The review states that despite much good work, digital transformation is currently fragmented across the system, split between different agencies and is “often overshadowed by requirements of the day-to-day”.
It continues: “Many senior leaders see digital as a separate not embedded enabler and there needs to be greater clarity on the roles of national, regional and local in driving transformation.”
The review goes on to state there is “variable commitment, experience and interest amongst senior leaders in digitally enabled system transformation, with too few integrative leaders able to effectively bridge managerial, clinical and digital”.
-----
Also, Philips Foundation is funding a cardiac rehab centre in Singapore.
By Adam Ang
November 26, 2021 02:34 AM
Medanta taps Qure.ai for AI-driven chest x-ray analysis
Medanta, a multi-speciality medical group in India, has partnered with Qure.ai to implement the latter's artificial intelligence software to enhance chest x-ray analysis.
The hospital group will be adopting the qXR software which automatically analyses chest x-rays and spots findings for better diagnosis and treatment. The AI tool can detect 30 abnormalities of the lungs, pleura, heart, bones and diaphragm.
"Medanta strives to deliver world-class healthcare through its high-end medical equipment and superior infrastructure. State-of-the-art technology is an essential aspect of healthcare delivery," Dr Naresh Trehan, chairman and managing director of Medanta, was quoted as saying in a news report.
The Qure.ai software has also been adopted by Fujifilm Corporation for its portable X-ray FDR Xair system. Through its recent partnership with AstraZeneca Malaysia, the startup has brought its x-ray software to some primary care clinics in Malaysia to support the early detection of lung cancer there.
-----
Interactive technology could help solve the problem of low vaccination rates in Europe.
By Anna Engberg
November 25, 2021 10:08 AM
A team of French cognitive scientists has addressed the urgent issue of vaccine hesitancy within many EU countries and proposes a new approach. With a study published in October this year, the researchers successfully demonstrated that the reluctance to be vaccinated could be decreased by deploying chatbot technology.
WHY IT MATTERS
The chatbot study involved researchers from the Centre National de la Recherche Scientifique (CNRS), the French National Institute of Health and Medical Research INSERM and ENS-PSL.
The study, published in the Journal of Experimental Psychology: Applied, found that interaction with a chatbot developed by CNRS, ENS-PSL and INSERM was able to reduce vaccination refusal by 20 per cent within a test group of 338 participants.
In the control group, which received only brief information about the COVID-19 vaccination, there were no comparable results in terms of general views and willingness to vaccinate.
-----
https://ehrintelligence.com/news/amazon-health-it-partnership-aims-to-enhance-clinical-communication
Amazon has partnered with a health IT company to create an ambient clinical intelligence tool that is set to streamline clinical communication.
November 24, 2021 - Health IT vendor Vocera has announced a collaboration with Amazon to build an ambient clinical intelligence solution in efforts to enhance the patient experience and streamline clinical communication.
The HIPAA-eligible solution will leverage a set of technologies from Alexa Smart Properties to allow patients and families to receive information about their stay through simple voice requests spoken to an Amazon Echo in the patient’s room.
The health IT will automatically answer common questions from patients that do not need clinical intervention, like visitor hours.
For requests that require clinical intervention, the tool will recognize keywords and phrases to route the message to the appropriate care team member. This is expected to streamline clinical communication by reducing unnecessary care team interruptions.
-----
Most patients and providers agreed patient-generated clinical notes via OpenNotes was a positive for appointments.
By Sara Heath
November 24, 2021 - Patient-generated health data and appointment agenda-setting via OpenNotes—a process that OpenNotes had dubbed OurNotes—can lead to both clinician and patient satisfaction, as well as increased patient engagement during clinical visits, the organization reported in a recent Journal of Medical Internet Research report.
These findings build on the literature confirming OpenNotes, or the practice of patients having free access to their clinical notes, as improving patient engagement and satisfaction. Starting in April of 2021, healthcare organizations have been beholden to providing open clinical notes as part of the 21st Century Cures Act and ONC information blocking final rule.
OurNotes is a little different, foremost because it is not a regulatory requirement. The practice allows patients to contribute some of their own medical information to their health records to be integrated with clinician notes.
The JMIR study looked at OurNotes efficacy at four academic medical centers, particularly testing the system for eliciting patient recollections of their previous medical encounter and three priority points for their upcoming medical encounter
-----
https://www.medpagetoday.com/opinion/second-opinions/95788
by Kathleen A. Hallinan, MD, MPH November 21, 2021
Americans have become the commodity in their own healthcare system. A patient has gone from being a person who has a relationship with a physician to a sheep that is herded through, with the corporate medical world making money off them with every move. Gone are the days when a physician would do rounds in the hospital in the morning, see patients in the office, follow them into the nursing home, and do home visits as they came to the end of their journey.
"Care" has now become a fragmented web of hospitalists, intensivists, and mid-level care that only remotely reflects the relationships that were the bedrock of the American medical system just 20 years ago.
What is the most substantial impact of this fragmented care? No one provider is the sole caregiver with total responsibility. Medicine has become the great handoff, with no one seeing the whole picture of the person in front of them. Patients have become a conglomeration of body systems and body parts to be fixed or addressed in a fragmented fashion, reminiscent of an assembly line.
Pretend for a moment you're a patient and you go to the emergency room for an acute issue. There, staff need only to verify that you will not expire within 24 hours, and out you go. If the risk is too high, then they hand you off to the hospitalist who will admit you, but if your condition worsens, there is often another handoff to an intensivist who manages the ICU. If more than one or two organ systems are affected then subspecialists will come and pore over the computer (rarely over the human) to see if the numbers in the electronic medical record are within their wheelhouse.
-----
https://www.mdlinx.com/physiciansense/what-can-be-done-to-fix-ehrs/
By Lara Becker on November 23, 2021
EHRs can make or break a physician’s efficiency, as well as their longevity in medical practice. The proof is in the research. For example, a 2020 Journal of Medical Internet Research study found that 74.5% of queried physicians said EHRs contributed to their burnout.
It was never supposed to be this way.
In 2009, President Barack Obama delivered a speech at an AMA conference saying EHRs “will not only mean less paper-pushing and lower administrative costs, saving taxpayers billions of dollars; it will also mean all of you physicians will have an easier time doing your jobs.”
Research demonstrates that EHRs have improved certain aspects of medical practice, however. For example, a 2012 CDC survey found that 88% of doctors thought EHRs produced clinical benefits for practice, and 75% felt that EHRs allowed a physician to deliver better patient care. Along these perceived benefits, however, comes the clerical burden of EHR data entry, which takes an undeniable toll on doctors.
What would solve the problem? PhysicianSense consulted several experts on the subject. The answer, it seems, must incorporate physician input, user experience (UX) design, and healthcare policymakers.
-----
Government review will examine the impact of devices such as oximeters on patients from different ethnic groups.
By Tammy Lovell
November 24, 2021 02:23 AM
The UK government has launched a “far-reaching review” into the impact of potential bias in the design and use of medical devices.
Race Equality Foundation CEO Jabeer Butt welcomed the review, but said it was not enough to explain the disproportionate deaths of Black, Asian and minority ethnic (BAME) people from COVID-19.
The review will examine medical devices currently on the market to identify where systematic bias and risk exist and make recommendations on how these issues should be tackled in the creation of medical devices from design to use.
It will also consider the enhanced risk of bias in the emerging range of algorithmic based data / artificial intelligence (AI) tools.
Medical devices such as oximeters will be examined to identify potential discrepancies in how they work for different ethnic groups and whether regulations mean there is a systemic bias inherent in medical devices.
-----
November 24, 2021
A randomized controlled trial across 8 acute care hospitals showed patients that were part of a Remote Patient Monitoring (RPM) program after surgery, were 5.3% less likely to be readmitted, 13.9% less likely to report pain 7 days after surgery, and 24.2% safer because medication errors were detected early on.
Background
The trial was conducted by Dr. Michael McGillion and Dr. PJ Devereaux of the Population Health Research Institute and McMaster University. They recently published their results in the British Medical Journal – “Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial.”
The objective of the study was to determine if virtual care, coupled with RPM had an impact on the outcomes of and reduced readmissions for patients discharged after non-elective surgeries versus standard care (no virtual care, no RPM). The study involved 905 adult patients across 8 acute care hospitals.
Participants in the experimental group received a tablet computer and RPM technology (provided by Cloud DX) that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days participants took daily biophysical measurements and photographs of their wound three times a day. This information was transmitted to the care team back at the hospital.
-----
Analysis | By Scott Mace | November 24, 2021
New management targets social determinants of health integration.
KEY TAKEAWAYS
· Data cleanup saved HIE from insolvency and continues to play a role in its goal of break-even operations by the end of 2022.
· First-in-nation statewide license of Findhelp.org expands HIE's role in integrating social determinants of health with data integration goals.
· FHIR-based data warehouse is poised to help insurers meet HHS 2022 nationwide regulation to exchange data in FHIR format.
· Beyond HIE partnership with Utah HIE expands regional effort to coordinate data exchange.
The Idaho Health Data Exchange (IHDE) overcame an existential crisis by modernizing its patient matching technology and reducing data duplication to less than 1%.
In this process, IHDE matched more than 5.1 million messages while reducing patient data duplication rates by 94%, going from 18% to 1% on identity resolution, yielding more than 2.8 million searchable patient records, and improving care across the state.
The 10-year-old data exchange began its turnaround two years ago, when it asked Capital Health Associates to modernize the exchange, says Hans Kastensmith, the contracted executive director of IHDE and a managing partner at Capital Health Associates.
Building upon a base stack of technology from Orion Health, Capital Health Associates adopted 4medica's Big Data MPI [master-patient index] and 4medica's “1% as a Service“ to provide a real-time, transaction cloud-based service to quickly assess, normalize and cleanse mismatched patient identity data as a foundation for patient safety, data integrity, and interoperability.
-----
https://ehrintelligence.com/news/ehr-documenation-styles-may-impact-work-hours-clinician-burden
Writing clinical notes in a localized time period in the morning or afternoon may lead to decreased clinician burden and EHR documentation times.
November 23, 2021 - First-year medicine residents who wrote clinical notes in a localized time period during the morning or afternoon spent less time at work, according to a study published in JAMIA. The study suggests the need for further research to examine how different EHR documentation styles may impact clinician burden.
Researchers examined progress note production styles for Internal Medicine residents at the University of California, San Francisco who started their first year on June 21, 2018, using unsupervised machine learning methods.
The progress notes covered 279 inpatient encounters in which patients were admitted during three two-week periods (last two weeks of June, first two weeks of July, and first two weeks of October) to capture a sample of periods in the academic year.
The study revealed several distinct user styles and potential relationships between these styles and work hours.
-----
https://healthitsecurity.com/news/zero-day-attacks-threaten-healthcare-cybersecurity
Zero-day attacks pose a serious threat to the healthcare sector and can be difficult to mitigate, HC3 warned in its latest threat brief.
By Jill McKeon
November 22, 2021 - The Health Sector Cybersecurity Coordination Center (HC3) issued a threat brief outlining risks and mitigation tactics associated with financially motivated zero-day attacks on the healthcare sector. By nature, it is impossible to eliminate zero-day attack risks, but patching systems regularly is the strongest form of defense.
The term “zero-day” indicates that there is no time between when the vulnerability is discovered by developers and when it is exploited by bad actors.
It can refer to a few different mechanisms, HC3 noted. A zero-day attack occurs when threat actors exploit a vulnerability before a patch can be developed and applied. Meanwhile, a zero-day exploit is a method that weaponizes a discovered vulnerability, and a zero-day vulnerability is an unknown flaw in a software program.
Notable zero-day attacks, regardless of industry, include a 2010 attack on an Iranian nuclear program that successfully caused centrifuges to self-destruct, and the 2021 SonicWall zero-day ransomware attack in which threat actors exploited a vulnerability and subsequently deployed FiveHands ransomware.
-----
Price transparency in commercial health plans makes cost reduction an imperative for healthcare providers
Nov 23 2021
Healthcare operating model expert , PA Consulting
The recent CMS hospital price transparency ruling requires providers to release negotiated rates for 300 “shoppable services” for each of their contracted payers. The ruling aims to help Americans understand the cost of a hospital item or service before receiving it.
CMS has also finalized the payer equivalent; payers will have to make their negotiated rates with in-network providers public in January 2023. As a result, payers, providers, and consumers will be able to compare rates across the healthcare system, making healthcare costs more transparent.
Price transparency will drive both providers and payers to understand their own businesses through the data they collect; which is a good thing. It is fair to say that businesses in all markets are becoming more data driven as they understand the value that data analytics can produce.
Organizations that seek to navigate this transition should start by finding the internal product owner for the chosen system and understanding the reports that can be generated. Often, the business and IT work together so that the business suggest areas they need analysis in or the problem they are trying to solve, then IT can advise on the potential solutions.
-----
Having an active patient portal account is linked to a shorter average length of stay in the hospital for both COVID-19 patients and heart failure patients, according to a recent analysis of data from Epic's Health Research Network.
For the study, researchers examined patient admissions for COVID-19 and heart failure alongside patients' engagement with patient portals. Results showed that having a patient portal account was associated with a shorter length of stay in the hospital.
COVID-19 patients with an active portal account had an average length of stay shorter by 0.09 to 1.1 days, while heart failure patients with portal accounts were associated with an average length of stay shorter by 0.3 to 0.6 days, according to the analysis.
-----
HC3 researchers say these hacks – where new vulnerabilities exploited before a patch can be applied – are on the rise.
By Kat Jercich
November 23, 2021 04:21 PM
The U.S. Department of Health and Human Services' cybersecurity arm issued a threat briefing this past week about "zero-day attacks" and their potential risk to the healthcare system.
"Mitigating zero-day attacks completely is not possible – by nature, they are novel and unexpected attack vectors," said the Health Sector Cybersecurity Coordination Center in a public presentation.
One helpful mitigation? "Patch early, patch often, patch completely."
WHY IT MATTERS
As the agency outlined in the briefing, a zero-day attack is defined as a vulnerability exploited by threat actors before a patch is developed and applied.
The number of zero-day exploits caught in the wild has skyrocketed this year: By September 2021, Massachusetts Institute of Technology researchers had tracked at least 66.
-----
https://ehrintelligence.com/news/ehr-sepsis-alert-volume-raises-clinician-burden-concerns
While hospital census declined during COVID-19, EHR sepsis alert volume increased by 43 percent, highlighting clinician burden concerns.
November 23, 2021 - Healthcare organizations that leverage the Epic Sepsis Model (ESM) experienced a 43 percent increase in EHR alerts during COVID-19, according to a study published in JAMA Network Open that raises clinician burden concerns.
Sepsis early warning systems aim to provide timely clinical decision support for recognizing and treating sepsis. Traditionally, these early warning systems have relied on simple clinical rules, like systemic inflammatory response syndrome criteria, to identify patients with possible sepsis. However, these systems have not been shown to reliably improve patient outcomes.
Systems like the ESM aim to improve sepsis detection through artificial intelligence algorithms. However, concerns have arisen recently regarding the potential for sepsis models to overwhelm clinicians with EHR alerts.
The University of Michigan paused ESM alerts in April 2020, about three to four weeks after its first COVID-19 hospitalization, when nurses reported that the system was over-alerting them and causing fatigue.
------
Researchers note that providers have raised concerns about alert fatigue from artificial intelligence-enabled sepsis models.
By Kat Jercich
November 23, 2021 12:18 PM
A research letter published in the Journal of the American Medical Association Network Open this week examined the number of alerts generated by the Epic Sepsis Model at 24 hospitals before and during the COVID-19 pandemic.
Researchers from the University of Michigan Medical School and Washington University School of Medicine found that the total alerts per day increased by 43% in the three weeks before and after the first case of COVID-19 in each health system.
"Although the increase in the proportion of patients generating sepsis alerts in this study can be explained by the cancellation of elective surgeries and a higher average acuity among the remaining hospitalized patients, the 43% increase in total alerts illustrates the increased alerting burden imposed by COVID-19 on a sepsis model," they wrote.
Epic declined to respond to requests for comment.
WHY IT MATTERS
As noted by the researchers, concerns have been raised about the potential for sepsis models to cause alert fatigue, leading to the University of Michigan to pause Epic-generated alerts in April 2020.
-----
https://ehrintelligence.com/news/indiana-hie-announces-data-sharing-network-nearly-covers-state
After large health systems joined the nonprofit HIE this year, the data sharing network now encompasses clinical data of 18 million patients.
November 22, 2021 - Indiana Health Information Exchange (IHIE) has announced that its data sharing network is close to covering the entire state of Indiana, according to reporting from The Hamilton County Reporter.
Large health system contributors in the Fort Wayne area joined the nonprofit HIE this year, filling a data sharing gap in the northeast region of the state.
“The COVID pandemic certainly highlighted the need for a statewide health information exchange to support public health, and each new facility added is a step towards a consolidated and statewide data exchange in Indiana,” Drew Richardson, vice president of product and business development at IHIE, told The Hamilton Country Reporter.
“While the focus has been primarily on public health and COVID, we are seeing tremendous value in these new data sources for all participants including health systems, providers, payers, and labs,” Richardson continued.
-----
Core components of a comprehensive security program include regular reporting of security deficiencies and having a designated CISO.
By Jill McKeon
November 22, 2021 - Just 32 percent of surveyed acute and ambulatory care organizations had a comprehensive security program in 2021, according to the College of Healthcare Information Management Executives (CHIME) “Digital Health Most Wired” survey.
CHIME surveyed thousands of ambulatory, acute, and long-term/post-acute (LTPAC) facilities to assess how and to what extent healthcare organizations are implementing information technology. Only 26 percent of LTPAC organizations were considered to have a comprehensive security program.
In 2020, 34 percent of organizations met the standards for a comprehensive security program. However, CHIME updated some of its standards in 2021 to reflect industry advances, raising the bar for surveyed organizations. In 2019, only 24 percent of organizations met the standards for a comprehensive security program.
Under the new standard, organizations must report security deficiencies and progress quarterly rather than annually, and they must give the board a security update semi-annually rather than annually. In addition, organizations must have a dedicated chief information security officer (CISO) with presence in the executive suite rather than just a director of security.
-----
November 19, 2021
Federal public health administrators are emphasizing interoperability as government agencies continue to implement electronic health records (EHRs) across federal public health agencies.
A litany of officials from government organizations including the Department of Health and Human Services and the Department of Defense joined a panel discussion Thursday talking about the health IT goals between federal organizations and the ongoing effort to implement EHRs into their daily business processes.
EHRs are digital copies of patient health records that turn a patient’s medical history into a single, shareable file to reduce the administrative and cost burdens and optimize clinicians’ ability to deliver positive health care outcomes.
A major goal of the current efforts to modernize and implement EHRs across several federal agencies hinge on sophisticated data collection and cross-department sharing capabilities, with a focus on helping patients access their records. As more vendors develop their own applications to access and transfer EHRs, compatibility issues between interfaces make it challenging to share patient data. Standardization of these platforms would facilitate patient data sharing between health care providers.
-----
https://www.healthcareitnews.com/news/tackling-challenge-integrating-telehealth-seamlessly-ehr
Ophir Lotan from telemedicine company TytoCare walks readers through this key task now that virtual care has gone mainstream because of COVID-19.
By Bill Siwicki
November 22, 2021 12:37 PM
Making caregivers' lives easier should be one of the primary goals of any healthcare provider organization's IT shop. Throwing too many solutions with too many workflows and too many log-ins at physicians and nurses is a recipe for failure.
With telehealth a mainstream technology today because of the necessities of the COVID-19 pandemic, caregivers need the technology to be a natural part of their workflow and an easy way to connect with patients. And many in healthcare have concluded the best place for telehealth to be initiated by caregivers is within a patient's electronic health record.
This has become the modus operandi of many healthcare provider organizations across the country. But it's not necessarily an easy get. That's why Healthcare IT News interviewed Ophir Lotan, vice president of product and customer success at telemedicine company TytoCare. Here, Lotan shares his expertise with the combined forces of telehealth and EHRs.
Q. When attempting to integrate telehealth with an EHR, what is the importance of synchronous versus asynchronous virtual care workflows?
A. When health systems are looking to integrate telehealth with the EHR, it's crucial they factor in both synchronous and asynchronous workflows. Synchronous telehealth appointments would be a typical virtual visit where the physician and patient are on a video call together in real time. When it comes to asynchronous telehealth, the patient would record any vital signs with a telehealth device on their own prior to the virtual appointment.
-----
https://www.healthcareitnews.com/news/emea/nhsx-and-nhs-digital-be-axed
The two tech bodies will merge with NHS England as part of restructure.
By Tammy Lovell
November 22, 2021 02:21 PM
The Department of Health and Social Care (DHSC) is due to announce that tech bodies NHSX and NHS Digital will merge into NHS England as part of a major restructuring.
In an internal email, seen by Healthcare IT News, NHSX CEO Matthew Gould said the brands would be “retired” to accelerate the digital transformation of the NHS.
According to Gould, NHS Digital will be incorporated into NHS England as soon as legislation allows. Ahead of legislative reform, NHS Digital will work in an integrated way with NHS England, and its CEO Simon Bolton will become the CIO of NHS England.
Bolton will report to Dr Tim Ferris, with a reporting line to Amanda Pritchard as well, and will sit on the NHSE executive team.
NHSX will evolve into the strategy function of the new transformation directorate. The strategy function will keep the joint unit status, and also include staff drawn from across the wider directorate. The strategy function’s role will continue to include the digital transformation of social care.
-----
The $17 billion deal marks the second time the cloud health IT vendor has been acquired in the past three years.
By Kat Jercich
November 22, 2021 11:04 AM
Cloud computing vendor athenahealth announced Monday that it would be jointly acquired by affiliates of Bain Capital and Hellman & Friedman for $17 billion.
The company, which offers electronic health record and physician practice tools, said the investment was expected to be completed in the first quarter of 2022.
Chair and CEO Bob Segert will continue in his position, said athenahealth in a press release, as will the current management team.
"Our employees, customers and partners are the source of our success and inspiration as we create a thriving ecosystem that delivers accessible, high-quality and sustainable healthcare for all," said Segert in a statement.
-----
https://histalk2.com/2021/11/19/weekender-11-19-21/
-----
Enjoy!
David.
This release appeared last week:
The Hon Sussan Ley MP
Minister for the Environment
The Morrison Government has announced two new Board members for the Sydney Harbour Federation Trust reflecting the importance of the Indigenous heritage of the sites, as well as the wider significance of the Harbour Trust to greater Sydney.
Minister for the Environment Sussan Ley said following the Morrison Government’s steps to ensure the ongoing future of the Harbour Trust in administering former Commonwealth defence sites such as Cockatoo Island, Headland Park and Sub Base Platypus, it was important to also ensure the Board brought together the right diversity of skillsets to plan for the future.
“I am pleased to announce that Tanya Denning-Orman, Director of Indigenous Content at SBS will join the Board along with City of Parramatta Lord Mayor Steven Issa,” Minister Ley said.
“Tanya brings a wealth of communications and broadcast experience to the Board and a strong understanding of Indigenous story telling.
“Steven’s appointment reflects the importance of local government perspectives in Heritage planning and place making.
“This is a unique time of opportunity for the Harbour Trust as it undertakes long-term master planning for Cockatoo Island and North Head Sanctuary, and it is important the right mix of Board and Management experience is in place to deliver the best possible outcomes.”
Biographies:
Tanya Denning-Orman
Tanya Denning-Orman, a proud Birri and Guugu Yimidhirr woman from central and north Queensland, has led National Indigenous Television since it joined SBS in 2012, and more recently became SBS’s first Director of Indigenous Content.
As a champion for strong Indigenous media, she also holds several industry board positions including with Media Diversity Australia, First Nations Media Australia, and the World Indigenous Television Broadcast Network.
Steven Issa
Steven is the Lord Mayor of the City of Parramatta and has served as a councillor since 2012. Steven moved and supported protections in the Parramatta Local Environmental Plan for all State Heritage Listed items including The Roxy Theatre and has supported the retention of Willow Grove and St Georges Terrace, as well as recognising the significance of Parramatta’s Female Factory.
Steven also served on the board of Western Sydney Region of Councils (WSROC) from 2012 to 2016, including time as Vice President. Steven is the Chief Digital Officer at Australian Digital Health Agency, is a former Director of Service NSW, University of Sydney lecturer and management consultant.
Both appointments are for two years. Mrs Denning Orman and Mr Issa are employed on a full-time basis by public statutory corporations and the Board positions are not remunerated.
The release is here:
https://www.miragenews.com/new-appointments-to-sydney-harbour-federation-681344/
So we have the Lord Mayor Of The City of Parramatta taking up extra roles while being the ADHA Chief Digital Officer. Who knew? I reckon a more focused role might be appropriate although I have always wondered just what a Chief Digital Officer actually does.
What do you think? A bit too much distraction from your main job or fine?
David.
