This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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."
Mon 6 Jun 2022 03.30 AEST Last
modified on Mon 6 Jun 2022 03.31 AEST
Twelve years after the
introduction of My Health Record, Australians are struggling to access their medical information,
while clinicians report frustrating difficulties uploading and finding vital
health details such as pathology results and diagnostic tests.
The latest annual report
from the Australian Digital Health Agency shows just 2.69 million of the 23 million people registered
for a My Health Record accessed it in 2020-21. While this is an increase of 14%
from the previous year, it was largely driven by people accessing Covid-19
vaccination records and Covid-19 test results.
The chief executive of the
Consumers Health Forum (CHF), Leanne Wells, said while upgrades to My Health
Record to include access to vaccination information and Advanced Care Plans
were welcome, day-to-day health records from consultations, emergency
department visits, hospital discharges, pathology, and diagnostic testing were
still missing from many records. This is despite more than $2bn
being spent on the system since it launched in 2012.
“These items represent the
vital health information that should be shared between health service
providers, however, consumers report that their expectations are not met when
these are not visible, or are only visible on supply from some, but not all,
providers,” Wells said.
The pandemic has had many
unforeseen consequences – and one of them seems to be a surge in the use of My
Health Record, the digital database intended as a ‘single source of truth’ for
patients and health professionals.
Figures published by the Australian Digital Health Agency (ADHA), which
oversees My Health Record, show an exponential
increase in visits to the website
in the past year.
The ADHA reports a figure of 1.57 million for April last year, which rose to a
high of 13.75 million in January. While the most recent statistics have fallen
from that peak – in April 2022, they stood at 4.83 million – they still reflect
a tripling in use from 12 months previously.
According to the organisation, those statistics 'are at a total viewing
level' so could include one person viewing several documents. It also
clarified that they are views by consumers, not healthcare providers (see
update below).
Regardless of who is looking, the numbers reflect a huge increase in use and
visibility for the patient database.
The ADHA attributes much of that to the pandemic, with upgrades last year
allowing vaccination certificates and details from the Australian Immunisation
Register to
be accessed on the database more easily.
It explains a 61% month-on-month rise in October last year by the lifting of
lockdown restrictions in NSW with residents looking for proof of vaccination.
The ADHA also links the January peak to soaring COVID-19 case numbers, which
again prompted people to check their vaccination status and PCR test results on
My Health Record.
One of the most pertinent questions is whether the surge in public familiarity
with the database will translate into greater reliability and detail within the
individual patient records.
For Western Australian GP Dr David Adam, who sits on the RACGP Expert Committee
– Practice Technology and Management (REC–PTM), there are positive signs. A
former IT administrator himself, Dr Adam believes there have been noticeable
improvements since the system changed from an opt-in database to opt-out in
early 2019.
‘I’ve definitely found it more useful recently compared to the early days,’ he
told newsGP.
‘Our public hospitals in Western Australia are being much more consistent about
uploading letters and results, and the Medicare, PBS and immunisation views are
very helpful at times, especially with new patients.’
The My Health Record database has been one of the flagship digital programs
under successive governments, although at times it has proved contentious.
The Australian National Audit Office reports a Federal Government investment
of $1.15 billion from 2012–2016, with another $374.2 million spent from
2017–2020. The Department of Health previously told The
Guardian almost $2 billion has been spent on the record since 2009.
After ‘opt-out’ legislation came into effect in 2019, the number of patients on
the database has more than quadrupled.
There are now 23.3 million active My Health Records, the ADHA reports – or more
than nine in 10 Australians. Of those registered for Medicare services in the
country, around 9.5% are thought to have opted out.
But while 99% of general practices have also now signed up, GPs report mixed
results on the level of detail contained within the records, with around one in
every 25 currently containing no data at all.
Among those is Dr Rob Hosking, who chairs the REC–PTM.
‘It is hit and miss as to whether results and other useful information is on My
Health Record,’ Dr Hosking told newsGP.
He believes more legislation is required to make it work better.
‘To make it more functional, it should be mandated that pathology and imaging
results are uploaded. Currently only some results are uploaded,’ he said.
‘Likewise, hospital discharge summaries should be mandatory to be uploaded as
well as sent to GPs.’
However, Dr Hosking also sounds a strong note of scepticism about the
likelihood of success.
More here:
Interesting that the usage increase was really a just a spike which
has since dropped off and COVID and all the testing has eased off.
It is also of note the ADHA makes a really weak response to the main
question as I see it.
“1. How far can GPs trust the completeness of
information on MHR? ADHA: My Health Record
contains a summary of key health information to support the delivery of health
care and is not intended to be a comprehensive record of an individual’s health
information. The completeness of the record is growing as more health
providers connect to and use My Health Record.”
249 – Digital health
strategies – Australia and beyond; Tjasa Zajc, Faces of Digital Health
Will the My Health Record
ever become a valuable infrastructure? Peter Birch is the founder and
host of the Talking HealthTech podcast and is one of the board members of…
249 - Digital health strategies - Australia and beyond; Tjasa Zajc,
Faces of Digital Health
In this episode, you'll
hear something slightly different; it's Pete getting interviewed by Tjasa Zajc
on her podcast; Faces of Digital Health. Pete and Tjasa discuss the My Health Record (MyHR), which over
twenty-three million Australians are currently using. They also explore the
opt-in and out controversy surrounding MyHR, clinicians' ability to connect to
the record and how that affects the record's completion status, including the
populations being covered and much more.
My Health Record's Progress
My Health Record is
undoubtedly an exciting piece of health tech solution, and it actually existed for quite a while but
lacked the public's interest. It was introduced as a means of having a central
health record for every Australian, and
for good reasons too. However, a lot of information
has to be loaded into the record, which relies on each person actually setting
it up by going through an arduous process. Then, what do we actually do with this PDF format
information?
MyHR then went from an
opt-in to an opt-out system, which worked for a while until questions
around data security and privacy came up from many concerned Australians. During COVID-19, much focus was placed on the MyHR since vaccines were administered, and the My Health Record was used as the
place of reference for vaccine certificates.
As such, there was a massive uptake of the record;
nonetheless, the challenge going forward will be to invest in additional use
cases that more of the public would see as beneficial and Interesting.
This is a strange piece which says the #myHR is ‘no good’ has cost
heaps and delivered little but that in the absence of any alternatives should be
persisted with and that clinicians should be paid to use it!
Summary: lets increase ongoing spend hoping that a 10 year failure will
suddenly start working!
Overall we are seeing a bizarre view that if 10 years of spend fails
to work that 20 or so will, and despite all its flaws all will come good in the
end! What nonsense I say!
There is really a lot of ‘magical thinking’ going on about the #myHR
and it really needs to stop!
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.
June 03, 2022
- eHealth Exchange, a health information exchange (HIE), announced
that the eHealth Exchange Hub platform surpassed one billion requests processed
for the first month ever in May 2022.
eHealth
Exchange’s Hub provides network members with an application programming
interface (API) that enables interoperability with five federal agencies and
the nation’s leading health systems, pharmacies, HIEs, medical groups, and
others to reduce information
sharing expenses and complexities.
“The platform
reduces the burdens of health information exchange on healthcare facilities,
meaning these facilities can enhance patient-centric services easily and
reliably,” Jay Nakashima, executive director of eHealth Exchange, noted in a
public statement.
“After
near-misses for months, we are proud to have hit this important milestone and
look forward to continuing to provide our network members with efficient and
cost-effective interoperability,” Nakashima continued.
Interoperability with open standards: let’s kindle a discussion about FHIR
The future
of healthcare systems may be open, but how are we going to get there? asks
Vivek Krishnan, chief technology officer at Alcidion Group. There’s no doubt
that OpenEHR and FHIR will both have a role to play, however, the UK seems to
be focusing on OpenEHR – when FHIR has a lot to offer trusts and suppliers.
DHI June 1
2022
The future of
healthcare systems lies in open standards that free data from traditional,
stand-alone silos and make it available to the many applications that need it.
But how are we going to reach that future?
Realistically,
we have two options: open Electronic Health Record, better known as openEHR and
Fast Healthcare Interoperability Resources, or FHIR. I’m not going to argue
that one is better than the other. They both have advantages and disadvantages
and they will both have a role to play in the digitisation of the NHS.
However, it
sometimes feels like openEHR has become the focus of attention in the UK and
I’d like to see more debate about the role of FHIR and open platform
architectures that use FHIR to natively extract, store and re-export data to
applications.
This is the
model that Alcidion uses in its Miya Precision platform, and I assert that it
has some benefits for innovative suppliers, trusts and Integrated Care Systems.
June 03, 2022
- HIPAA physical safeguards are an essential aspect to any covered
entity’s PHI security, but could easily be overlooked. Technical safeguards and
administrative safeguards could easily be pushed to the forefront of a covered
entity’s overall health data security plan. However, physical safeguards are
also critical, and must be able to work seamlessly with the other two federal
requirements.
Whether an
organization needs to review its storage methods for portable devices, or is
considering a new system for its security cameras, understanding the basic
needs for HIPAA physical safeguards is an important aspect in keeping an
organization’s sensitive data secure.
What are
HIPAA physical safeguards?
The HIPAA
Security Rule describes physical safeguards as the “physical measures,
policies, and procedures to protect a covered entity’s electronic information
systems and related buildings and equipment, from natural and environmental
hazards, and unauthorized intrusion.” Essentially, a covered entity needs to
consider all physical access to ePHI. Everything from the healthcare
organization office, to employees’ homes, or even a separate physical storage
center needs to be properly secured.
For
more than a quarter of a century, pundits and prognosticators have said that a
revolution was forthcoming for connected healthcare.
Yet
it wasn’t until early 2020, when the pandemic arrived, that there was a sudden
and urgent need to pivot to a connected framework. Suddenly, doctors and other
medical professionals began substituting in-person visits with video consults and remote monitoring. Smart watches,
digital thermometers and blood oximeters played a crucial role in collecting
and sharing data.
This
rapid shift to connected healthcare has unleashed shockwaves. “COVID has pushed
electronic health and wellness devices into the forefront,” says Allyson Hein,
medical device industry lead for Clarkston Consulting. “These systems and
devices have the potential to completely reshape care.”
For
healthcare executives, the stakes are enormous. Disruption that previously hit
retail, financial services and many other sectors is now descending on
healthcare. “There are remarkable opportunities to drive cost and quality
improvements but also introduce new products and services,” says Benjamin
Schooley, associate professor of Integrated Information Technology at the
University of South Carolina.
Goodbye Pagers, Hello Clinical Texting ― How to Make the Transition
Painless
Nicole Pajer
June 02, 2022
Despite
the consumer shift from pagers to cellphones and smartphones, paging has
remained a communication staple among healthcare professionals.
But
that's changing. More and more hospitals are replacing pagers with clinical texting
systems that allow clinicians to send and receive patient-care messages using
smartphones.
"This
is a trend we see happening all over in medicine," says Joy Lee, PhD, a
research scientist at Regenstrief Institute and assistant professor of medicine
at Indiana University School of Medicine.
These
messages could be team communications ("I saw the patient you wanted a
consultation for in room X") or, say, an update on a patient's blood sugar
level. "It's a lot of informational transactions that would be happening
in healthcare anyway," Lee says. "It's just now happening over
smartphones rather than pagers."
To improve EMR satisfaction, work on speed and reliability first
Providers would be wise to improve their EMR system response time and
reliability, as these two measures critically influence clinician satisfaction.
These improvements are acutely needed amid healthcare’s workforce shortage —
burnout and EMR dissatisfaction are key factors associated with clinicians'
likelihood to resign.
Nearly
half of clinicians think their EMR does not load fast enough, and nearly a
quarter agree their system is not available when they need it, according to a
KLAS report
released Wednesday.
Given
the survey response, providers would be wise to improve their EMR system
response time and reliability, as these two measures critically influence
clinician satisfaction. These improvements are acutely needed amid healthcare’s
workforce shortage — a separate KLAS report
released in April found that burnout and EMR dissatisfaction are key factors
associated with clinicians’ likelihood to resign.
For
its most recent report, KLAS surveyed more than 295,000 clinicians across more
than 270 healthcare organizations. Only 18 organizations had 90% of their
respondents report few or no difficulties with EMR availability. Given that
widespread dissatisfaction abounds regarding EMRs in general, it was perhaps
not a surprise that no single organization had more than 90% respondents
agree that they encountered few or no issues with EMR availability.
One
frustrated nurse respondent responded:
“There
are numerous alerts that pop up all the time that are not helpful at all — not
at all. These alerts are repetitive, inappropriate, immediately dismissible,
and just another button to push when I am already busy. I have been waiting for
10 minutes for the EMR to load, and my patient who just had major surgery is
screaming in pain.”
The Challenges of Reducing Clinicians’ Administrative Burdens
June 3, 2022
The
following is a guest article by Joel Landau, Founder and Chairman of The Allure Group.
Sadly,
most of us realize now that the promise of a “paperless society” is unlikely to
become a reality. Despite technology’s ability to eliminate some of the more
tedious tasks like filling out endless insurance forms, and paying bills,
paperwork still exists. And even though more and more information is shared
online, completing such forms is time-consuming as well, and can sometimes
actually create more work. Nowhere is this more apparent than in the healthcare
field. Despite the increased use of electronic health records (EHRs) and other
technology, physicians, nurses, and other healthcare providers are reporting
record levels of burnout, compounded by the stress placed on clinicians by the
seemingly unending COVID-19 pandemic.
Studies
show that up
to 42 percent of doctors suffer from burnout, and the main reason cited is
too many administrative tasks, along with too many hours spent at work. Most
physicians work close to 51 hours a week, with almost half of their workday
spent on administrative work rather than patient care. Administrative burden
plays a key role in heightened stress levels for healthcare workers. Doctors
report wasting an average of 45 minutes a day using outdated communication
technology, resulting in a lack of productivity and costing U.S. hospitals more
than $8 billion annually.
To
alleviate clinician administrative burnout, the Center for Medicare and
Medicaid Services (CMS), the
American Medical Association (AMA), and other regulators and payers have
eliminated some nonessential administrative tasks and reduced preexisting
constraints on team-based care, especially during and after the pandemic. Even
before COVID-19 emerged, the American
College of Physicians and CMS
adopted a mindset of “Patients over Paperwork” to help providers spend more
time with patients and less on administrative chores.
ONC 2015 Edition Health IT Adoption Reduced Duplicate Orders
ONC 2015
Edition Health IT adoption decreased the likelihood of duplicate orders by 40
percent. But, hospitals that also engaged in interoperable data exchange were even
less likely to have duplicate tests.
June 02, 2022
- The Office of the National Coordinator for Health IT’s (ONC’s) 2015
Edition Health IT Certification Criteria which in turn reduced
the likelihood of duplicate orders among hospitals that adopted the edition, a
boon for health data interoperability, the agency celebrated.
Unnecessary duplicate laboratory testing is
common and costly. Experts estimate that in 2015, $65 billion was spent on
lab testing alone, with nearly 20 to 30 percent of that used to perform
unnecessary duplicate tests. Additionally, unnecessary duplicate medical
imaging adds roughly $30 billion to annual US healthcare costs.
The study,
published in the Journal of the American Medical Informatics Association,
examined the impact hospital adoption of the 2015
Edition Health IT Certification Criteria (2015 Edition) had on
duplicate lab and imaging tests.
Machine-Learning Platform Can Accurately Predict Surgical Complications
Researchers
from the University of Florida have successfully developed a machine-learning
model to help clinicians predict and address postoperative complications.
June 02, 2022
- University of Florida (UF) researchers have
developed a machine-learning (ML) platform, called MySurgeryRisk, that can
predict surgical complications as accurately as clinicians.
Surgery and
potential postoperative complications provide considerable challenges for
clinicians and patients. According to a study published in BMC
Surgery last year, the total volume of major surgeries performed annually worldwide
was estimated to be 312.9 million in 2012, and an estimated 7-15 percent of
these patients would experience a major complication.
The
researchers created MySurgeryRisk to help prevent some of these outcomes by
predicting risk rates for patients planning to undergo surgery. The platform
was developed using 74,000 procedures involving 58,000 adult patients at UF
Health, and it was trained to predict surgical complications using 135
variables extracted from patient EMRs. These variables included clinical,
laboratory, pharmacy, demographic, and other data.
The algorithm
was then tasked with predicting prolonged intensive care unit stays and
mortality risk after procedures. The platform also predicts the risk of eight
major surgical complications, including neurological issues, cardiovascular
issues, sepsis, and acute kidney injury.
Telehealth Raises Visit Completion Rate by 20% for Rural Residents
A study
found that telehealth can be used to expand access to primary care in rural
areas as it can help increase the proportion of appointments completed.
June 02, 2022
- Using data from a rural Appalachian population, a study published in the
Journal of the American Board of Family Medicine found that telemedicine is an
effective alternative to in-person care for rural residents, helping to drive
up appointment completion rates.
In the study,
researchers examined a sample of 110,999 patient visits, 13,013 of which
occurred through telemedicine. All data came from the West Virginia University
Department of Family Medicine from January 2019 to November 2020. Researchers excluded
data belonging to patients who lived more than 60 miles outside the West
Virginia state line.
Researchers
conducted a retrospective cohort study, using the data to determine any
correlation between the rate of visit completion and the setting in which a
visit occurred.
They found
that telehealth can drive appointment completion rates up by about 20 percent.
June 02, 2022
- Federal Bureau of Investigation (FBI) Director Christopher Wray revealed
that Iranian government-backed hackers attempted to execute a cyberattack
against Boston Children’s Hospital in June 2021.
In a speech
delivered at Boston College during the Boston Conference on Cyber Security,
Wray called the incident “one of the most despicable” cyberattacks he had ever
seen.
“We got a
report from one of our intelligence partners indicating Boston Children’s was
about to be targeted. And, understanding the urgency of the situation, the
cyber squad in our Boston Field Office raced to notify the hospital,” Wray
said.
“Our folks
got the hospital’s team the information they needed to stop the danger right
away. We were able to help them ID and then mitigate the threat. And quick
actions by everyone involved, especially at the hospital, protected both the
network and the sick kids who depend on it.”
Oracle
announced on Wednesday that, more than five months since the deal was first
announced, all necessary antitrust and other regulatory approvals have been
secured for its proposed purchase of Cerner, and that the acquisition should be
finalized early next week.
WHY IT
MATTERS
Most notably, that includes the unconditional antitrust clearance from the
European Commission clearance that Oracle gained this past week. Earlier this
year, the window for the Federal Trade Commission and the Department of
Justice's own review of the deal had been extended to Feb. 22.
With
those approvals in hand, Oracle says it now expects to complete the acquisition
with an all-cash tender offer for $95 per share, totaling approximately $28.3
billion, that's immediately accretive to Oracle's earnings.
The
company says it expects the deal to close next week, on June 6, subject to the
conditions described in the statement filed with the Securities and Exchange
Commission on January 19, and presuming other closing conditions are met.
Faulty Pulse Oximetry Readings Delayed COVID-19 Care For Minority Groups
Due to
inaccurate pulse oximetry measurements, Black and Hispanic patients were less
likely to be recognized as eligible for COVID-19 treatment than White patients,
a new study shows.
June 01, 2022
- Pulse oximeters often showed inaccurate blood oxygen readings for Asian,
Black, and Hispanic patients resulting in delayed COVID-19 care for these
populations during the pandemic, according to
a new study.
Published in
JAMA Internal Medicine, the study included clinical data from five referral
centers and community hospitals in the Johns Hopkins Health System. Data from
patients with COVID-19 who self-identified as Asian, Black, Hispanic, or White
were included in the study.
Researchers
identified patients with occult hypoxemia, that is, patients with oxygen
saturation levels of less than 88 percent in arterial blood (SaO2) and
concurrent pulse oximetry (SpO2) readings between 92 percent and 96 percent.
They then compared the proportion of patients with occult hypoxemia by race and
ethnicity.
Of 7,126
patients with COVID-19, 1,216 Asian, Black, and Hispanic and 460 White
individuals had 32,282 concurrently measured oxygen saturation levels in
arterial blood and by pulse oximetry. Nineteen Asian, 136 Black, and 64
Hispanic patients had occult hypoxemia compared with 79 White patients.
Patient Engagement Technology Not Aligned with Patient Expectations
There is a
gap between what patient engagement technology offers and patient expectations,
as 67 percent of patients want the ability to schedule and reschedule healthcare
appointments, but most don’t have it.
June 01, 2022
- Patients are demanding more digital health tools that allow them to
manage their care, yet this is the area patient engagement technology vendors
most fall the most of patient expectations, the latest KLAS report noted.
The Patient
Perspectives on Patient Engagement Technology 2022, obtained via email,
gathered survey responses from 12,861 patients across the US, specifically
looking at patient perspectives around healthcare information technology (HIT).
The pandemic
has emphasized the importance of accommodating patient needs to improve care
quality and outcomes. Still, patients are left out of conversations about
healthcare information technology (HIT).
IT Specialist Charged in Healthcare Cyberattack Highlights Insider Threat
Risks
An IT
specialist has been indicted on a federal criminal charge after allegedly
hacking into a Chicago healthcare organization’s server where he formerly
worked.
June 01, 2022
- An IT specialist has been charged for allegedly hacking into a Chicago
healthcare organization’s server in 2018, the Department of Justice (DOJ) announced.
Aaron
Lockner, 35, of Downers Grove, Illinois, formerly worked for an IT company that
had a contract with the impacted healthcare organization. As a result, Lockner
had access to the healthcare organization’s computer network.
Two months
before the incident, Lockner was allegedly denied an employment position at the
healthcare company. A few months later, Lockner was terminated from the IT
firm.
According to
the indictment, Lockner allegedly “knowingly caused the transmission of a
program, information, code, and command, and as a result of such conduct,
intentionally caused damage without authorization to a protected computer.”
ChristianaCare rolls out 'cobots' to help nurses with nonclinical tasks
The
"collaborative robots," known as Moxi, will be linked with the Delaware
health system's Cerner EHR. They're designed to make deliveries and
collections, helping ease clinicians' workload and enabling them to focus on
care.
ChristianaCare
this week announced some new help to augment its workforce: robotic assistants
that can help nurses and other hospital staff spend more time with patients by
automatic certain time-intensive tasks.
WHY IT
MATTERS
The technology, called Moxi, is a collaborative robot that can work alongside
nurses and interact with them directly, performing nonclinical tasks such as
deliveries and pickups to enable them to focus on care delivery.
ChristianaCare
purchased five of these 300-pound "cobots" – which can work 22-hour
shifts, be fully charged in two hours and carry up to 70 pounds – with a $1.5
million grant from the American Nurses Foundation.
The
Moxi cobots will soon be integrated with ChristianaCare's Cerner electronic
health record platform, officials say.
Remote learning apps shared children’s data at a ‘dizzying scale’
The
educational tools used by students during the pandemic shared their information
with advertisers and data brokers that could track them around the Web, an
international investigation found
Millions of
children had their online behaviors and personal information tracked by the
apps and websites they used for school during the pandemic, according to an
international investigation that raises concerns about the impact remote
learning had on children’s privacy online.
The
educational tools were recommended by school districts and offered interactive
math and reading lessons to children as young as prekindergarten. But many of
them also collected students’ information and shared it with marketers and data
brokers, who could then build data profiles used to target the children with
ads that follow them around the Web.
Those
findings come from the most comprehensive study to date on the technology that
children and parents relied on for nearly two years as basic education shifted
from schools to homes.
Researchers
with the advocacy group Human
Rights Watch analyzed 164 educational apps and websites used in 49
countries, and they shared their findings with The Washington Post and 12 other
news organizations around the world. The consortium, EdTech Exposed, was
coordinated by the investigative nonprofit the Signals Network and conducted
further reporting and technical review.
Improving data capacity for maternal health research through EHR data
standards
Electronic
health records collect a wealth of data that researchers can use to improve
care for mothers and infants. Linking it with other data creates a powerful
resource to learn more about clinical and SDOH factors that affect pregnancy.
Maternal
mortality rates in the U.S. have climbed in recent years. Moreover, mortality
rates are significantly higher for Black women and American Indian and Alaska
Native American women than the rest of the population. Improving maternal
health outcomes and eliminating disparities are ongoingpriorities for the Department of Health and Human Services,
reinforced by the Biden-Harris administration.
While
progress has been made, there remain opportunities to improve the collection, linkage,
and analysis of data collected at the point of care. Strengthening the quality
of clinical data holds enormous potential for improving maternal health
outcomes as well as supporting patient-centered outcomes research on the
effectiveness of maternal healthcare services and interventions.
A
key need is for better data standards in electronic health records to
understand possible risk factors for maternal mortality and poor maternal and
infant health outcomes. EHR data differ by clinical settings and data
standardization across systems is essential for meaningful and unbiased use for
research. Furthermore, data standards must be specific for maternal health to
facilitate data linkages for a life span approach to women’s health that also
includes their infants’ health.
Data standardization, interoperability are critical to progress
EHRs
collect a wealth of data that could be used by researchers to provide a more
complete picture of the health and healthcare for pregnant women and mothers.
Linking EHR data with other data – such as health insurance claims, social
determinants of health, or mortality data creates a powerful resource for
researchers to generate evidence about the clinical, social, and demographic
factors that affect pregnancy outcomes for both mother and infants.
Researchers
from the Yale School of
Medicine have found that electronic health record (EHR) alerts can help
improve the quality of care for outpatients with heart
failure with reduced ejection fraction (HFrEF). The group shared its
findings in the Journal
of the American College of Cardiology.[1]
“Efforts
aimed at optimizing guideline-directed medical therapy (GDMT) in patients with
HFrEF are abundant across hospitals and healthcare systems, but there is
limited evidence to support whether such resource-intensive interventions have
any demonstrable benefit,” wrote first author Lama
Ghazi, MD, PhD, a fellow with Yale’s Clinical and
Transnational Research Accelerator, and colleagues.
Ghazi
et al. examined the impact of an EHR-based alert system designed, with help
from physicians, to inform healthcare providers about key data such as the
patient’s current left ventricular ejection fraction (LVEF), blood pressure and
heart rate.
The
alert also provides a detailed rundown of which recommended medications the
patient is and is not currently taking and FDA-supported details about each
medication. The provider receiving the alert is then asked to respond to the
alert by saying, “I will adjust medications,” “medication changes not
clinically indicated” or “defer for other reason.” A free text field is also
provided if the individual responding to the alert wants to add any additional
comments.
Toku
Eyes, a New Zealand-based healthcare AI company, is launching its tool that
assesses heart risk through a retinal scan in the U.S.
The
tool, called ORAiCLE, uses an AI platform to identify cardiovascular threats
more accurately than existing risk calculators, the company claims. The
platform recognizes subtle changes in aspects like blood vessels and
pigmentation to identify a person’s risk of a stroke or heart attack in the
next five years.
Many
Americans with diabetes are at risk of long-term complications like heart
disease and blindness. Early diagnosis is critical for mitigating morbidity,
but diagnosis has historically been a challenge.
“If
you can see the future, you can change it,” Ehsan Vaghefi, co-founder and CEO
of Toku Eyes, said in an announcement. “By looking inside the eyes, we get an
in-depth view of what is happening inside the entire body to better assess the
risk factors of each individual and identify high-risk individuals before their
condition worsens. Our goal is to make health screening simple and easy to
access for the entire population so we can get in front of underlying health
risks and improve patient outcomes.”
May 31, 2022
- Variation in the adoption of Logical Observation Identifiers Names and
Codes (LOINC) codes has hampered laboratory data interoperability, according to
a study
published in JAMIA.
The objective
of the (LOINC)-to-In Vitro Diagnostic (LIVD) specification, required by HHS for
COVID-19 reporting, is to define an industry format to facilitate the
publication of LOINC codes for vendor IVD tests and results.
Researchers
compared gaps and similarities between diagnostic test manufacturers’
recommended LOINC codes for 331 tests and the LOINC
codes used in five medical center laboratories for the same tests.
The medical
centers varied in organizing, categorizing, and storing LIS catalog
information, impacting data quality and interoperability.
The study
authors noted six key findings:
Medical center LIS test catalogs
included data quality inaccuracies with LOINC, such as using codes that
were not proper LOINC codes, trial LOINC codes, deprecated LOINC codes,
and discouraged LOINC codes.
Medical center laboratory
information system (LIS) catalogs contained duplicative information or
tests that changed meaning over time.
Medical centers noted that the LIVD
catalog is helpful as a centralized platform, taking away LOINC guesswork.
Medical Centers also said the LIVD
catalog is helpful in the selection of LOINC codes associated with
specific COVID-19 testing platforms.
There were minor inconsistencies in
how manufacturers organized and stored IVD test information within LIVD
catalogs, likely due to not using the same version of the LIVD standard.
There is potential for the LIVD
catalogs to help improve semantic interoperability and LIS data quality.
There is also room for improvement of the LIVD catalog data elements and
accessibility of LIVD files by labs.
Researchers Call for ‘Distributed Approach’ to Clinical AI Regulation
Public
health researchers argue that the centralized regulation of artificial
intelligence at the national level is not sufficient for safety, efficacy, and
equity.
May 31, 2022
- Researchers argue that the national, centralized regulation of clinical
artificial intelligence (AI) is not sufficient and instead propose a hybrid
model of centralized and decentralized regulation.
In an opinion
piece published in PLOS Digital Health, public health researchers at
Harvard note that the increase in clinical AI applications, combined with the
need to adapt applications to account for differences between local health
systems, creates a significant challenge for regulators.
Currently,
the US Food and Drug Administration (FDA) regulates clinical AI under the
classification of software-based medical devices. Medical device approval is
typically obtained via premarket clearance, de novo classification, or
premarket approval. In practice, this usually involves the approval of a
“static” model, meaning that any change in data, algorithm, or intended use
after initial approval requires reapplication for approval. To receive
approval, developers must demonstrate a model’s performance on an appropriately
heterogeneous dataset.
To improve
parts of this process, the FDA has proposed a regulatory framework focused on
modifications to clinical AI within the context of Software-as-a-Medical-Device
(SaMD). This framework expands on the existing approach by adding new
post-authorization considerations that are expected to be of greater importance
to clinical AI, including recommendations for predetermined change control
plans. These plans require the manufacturers of algorithms to specify which
parameters of the application they intend to modify in the future and the
intended methodology to operationalize those changes.
The
Department of
Veterans Affairs will be required to regularly report the performance --
including incidents that risk patient safety -- of its troubled electronic
health records systems to Congress under new legislation headed to the
president's desk.
The
Senate approved a bill Thursday to require the VA to submit quarterly reports
to lawmakers on the performance and costs of the Electronic Health Record
Modernization program, or EHRM. The bill already passed the House in a voice
vote in November, meaning it now heads to President Joe Biden for his
signature.
A
VA hospital in Spokane, Washington, was forced
to suspend patient admissions and appointments after the records system,
estimated by the agency to cost $16.1 billion, crashed in March. Multiple
inspector general reports and news stories have highlighted issues with the
rollout of the system that risked patient safety, as well as cost overruns.
"The
VA, and consequently our nation, has invested a great deal of time and money
into the VA Electronic Health Record Modernization program," Senate
Veterans Affairs Committee ranking member Sen. Jerry Moran, R-Kan., the lead
sponsor of the Senate version of the bill, said in a statement.
Will the NIS2 directive on cybersecurity be enough?
The EU is
close to approving a new cybersecurity directive. Will it protect healthcare
organisations from hackers?
May 31, 2022
11:57 AM
The
European Council and Parliament reached an agreement on the directive known as
Network Information Security directive (NIS2) earlier this month. Formal
approval is expected over the next few weeks, with the French presidency
“optimistic” that a final draft will be ready before its term ends, according
to an EU source.
The
new cybersecurity directive will cover the healthcare sector more broadly than
the previous act. It includes medical device manufacturers and acknowledges the
“increasing security threats that arose during the COVID-19 pandemic.” In the
provisionally-agreed text, organisations that do not comply may be fined up to two per cent of annual
revenue, or up to €10 million.
Greater
collaboration means greater risk
But
researchers have already expressed concerns about the directive’s potential to
overlap with other pieces of legislation, such as governing medical
devices and requirements on serious-incident reporting. This could create
uncertainty, legal scholars say. Further, there are broader tensions
affecting the EU’s cybersecurity policy. Some experts pointed out that responsibilities are awkwardly split
between member states and the EU; others worry that that cyber concerns are not sufficiently
integrated with policy development.
Robert Krimmer is
professor of e-Governance at the University of Tartu in Estonia, where his
research focuses on digital transformation, cross-border services and
developing a digital society. He says that when it comes to cybersecurity a
coordinated approach across boundaries is vital, particularly when citizens are
involved.
Drummond
Group this past week announced the launch of its new Pediatric Health IT
Certification Program.
WHY IT
MATTERS
The program aims to build upon the Office of the National Coordinator for
Health IT's guidelines for voluntary certification of electronic health records
used by pediatricians.
It
will provide a Drummond Certified certification seal to health IT software that
successfully passes specified use cases and is therefore recognized for
excellence in pediatrics testing. It will also enable IT vendors to
differentiate themselves in the marketplace by showing advanced capabilities
that go beyond baseline certifications.
For
the pilot project of the certification program, Drummond will be drawing on feedback
from a trio of health IT companies: NextGen Healthcare, Office Practicum and
PCC.
They're
helping finalize the test scripts which are based upon the 10 recommendations
from the ONC in its 21st Century Cures Act Final Rule, the HL7 Pediatric Care
Health IT Functional Profile R2.1 published in May 2022, and the Agency for
Healthcare Research Children's EHR Format 2015 Priority List to advance child
health, such as through interoperable immunization data for health systems,
schools and public health agencies.
Smart
jumpsuits for babies and precision oncology are some of the innovative ways
that AI could be used to turn data into actionable insights, which will be
explored in more detail at HIMSS22 Europe in June.
Can
you imagine a future in which babies wear smart clothing to track their every
move? It may sound like something from science fiction, but a romper suit being
piloted in Helsinki, Copenhagen, and Pisa does exactly that.
The
‘motor assessment of infants jumpsuit’ (MAIJU) looks like typical baby
clothing, but there is a crucial difference – it is full of sensors which
assess child development.
“MAIJU offers
the first of its kind quantitative assessment of infant’s motor abilities
through the age from supine lying to fluent walking,” explains Professor Sampsa
Vanhatalo, project lead at the University of Helsinki. “Such quantitation has
not been possible anywhere, not even in hospitals. Here, we are bringing the
solution to homes, which provides the only ecologically relevant context for
motor assessment.”
Vanhatalo describes
the path from wishful thinking about a solution to a possible clinical
implementation as a “windy road”.
The
restructuring of the Home Affairs Department by the new Labor government and
the ongoing review of surveillance powers offers an opportunity to “undo” many
of the privacy-invasive digital-focused laws passed during the Coalition’s time
in power, Deakin University senior lecturer Dr Monique Mann says.
Labor
this week unveiled its Administrative Arrangements Order, revealing that
responsibility for the Australian Federal Police (AFP) from the Department of
Home Affairs to the Attorney-General’s Department.
This
comes five years after former Prime Minister Malcolm Turnbull moved the AFP
into the new Home Affairs super-portfolio.
The
new order “transfers responsibility for criminal justice, law enforcement
policy and operations, and protective services from the Home Affairs portfolio
to the Attorney-General’s portfolio”.
Clare O’Neill has been appointed as the new
Minister for Home Affairs and Cyber Security.
The former Coalition government passed a
number of digital surveillance laws during its recent time in government
through Home Affairs, handing significant new powers to the AFP and other
agencies. These included the mandatory metadata retention laws,
encryption-busting powers and the Identify and Disrupt Act.
While in Opposition, Labor offered support
to all of these pieces of legislation, which the Coalition argued were about
national security.
This transfer of power away from Home
Affairs, along with the ongoing
review into Australia’s surveillance laws, presents a significant
opportunity to unwind some of these digital law enforcement powers, Dr Mann
said.
“Home Affairs as a super agency under
[former minister Peter] Dutton in particular was a terrible bureaucratic
structure in relation to having all of these agencies in this super department,
with some concerning issues in relation to independence. It’s good that’s
starting to perhaps be wound back, but what that looks like and how it operates
in practice we don’t know,” Dr Mann told InnovationAus.com.
“This is an opportunity to potentially undo
all the things passed under the Liberal government, but I’m also a bit reticent
that there will be any substantive change because all these laws were passed
with bipartisan support from Labor.
“The broader reform process underway is an
opportunity to undo or reconsider the legal framework governing the exercise of
surveillance powers in this country. This is a viable opportunity to make
changes and I’ll be interested to see the extent to which Labor diverts from
their predecessors and starts making meaningful reform that protects the rights
of citizens as opposed to the empty arguments in relation to national
security.”
If this review was to get more balance in
these powers to watch and intrude I reckon it would be a very good thing.
Police always want more powers in this area and can always find some example
where they could help them – often to the detriment of a citizen who may or may
not be finally found to have acted criminally. Then what would regularly happen is that an over the top law would be
proposed to ‘fix’ the problem and if the Opposition resisted they were labelled
as ‘soft on crime’ and would roll over – while all the time bleating they were
not happy – but not having the guts to actually refuse to pass the proposed law!
We saw mumberless examples over the last 9 years
on laws relating to terrorism, drug suppression and so on. Interestingly we saw
few prosecutions and a number of times the laws were found to be invalid when
tested.
While moving these laws into a better balance
between freedom from surveillance and proper monitoring it might also be a good
idea the ensure the modernised Privacy laws are also made fit for purpose and
that individuals have better protection against privacy breaches and abuse of
personal information. Better funding for the Privacy Commissioner would also
not go astray I believe.
Overall I reckon we have been sold out in
terms of our individual rights and privacy and some shift of the balance back
to protection of individual rights may be a very good thing! We could also do
with clarity and national consistency of our health information privacy laws!
A good first step might be to outlaw any
form of secret trials – to ensure equal access to justice. I find this sort of
power pretty troubling….
You can read about current an example case
here:
Collaery Trial Date Set: Federal
Government Continues to Prosecute Whistleblowers
