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."

Sunday, September 11, 2022

AusHealthIT Poll Number 648– Results – 11th September, 2022.

Here are the results of the poll.

Are The State Health Systems Doing Enough To Support Nurses Learning About, Adopting And Using Digital Health?

Yes                                           34 (59%)

No                                            20 (34%)

I Have No Idea                          4 (7%)

Voters: 58

An interesting vote suggesting a majority think the State Health Systems are doing a reasonable amount to to support nursing digital health usage.

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. and a clear outcome. 

4 of 58 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.

 

Saturday, September 10, 2022

Weekly Overseas Health IT Links –10th September, 2022.

Here are a few I came across last week.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment

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https://ehrintelligence.com/news/surescripts-facilitates-health-data-exchange-for-about-20-of-americans

Surescripts Facilitates Health Data Exchange for About 20% of Americans

Surescripts enabled health data exchange for 622 million clinical documents during the first six months of 2022, an increase of 76 percent over 2021.

By Sarai Rodriguez

September 02, 2022 - In the first six months of 2022, healthcare interoperability has grown tremendously, according to Surescripts, which says it has supported health data exchange for nearly one-fifth of Americans.

Providers used Surescripts Record Locator & Exchange to access health records for more than 62 million patients. Additionally, more than 622 million clinical documents were exchanged in the first six months of 2022, representing a 76 percent increase over the same time period in 2021.

Surescripts aims to simplify how providers access patient records and care histories to inform patients of diagnosis, treatment, and prescribing, while also eliminating communication barriers that impact efficiency and overall cost of care.

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https://www.digitalhealth.net/2022/08/special-report-data-security/

Special Report: Data Security

As technology in healthcare settings becomes more prominent, so too has the need for robust data security. As the way patient data is used and stored has moved away from more analogue means such as paper filing systems, the approach to data security must also change.

30 August, 2022

For Johan Åtting, chief information security officer (CISO) at Sectra, security simply cannot be an afterthought.

“A key concept that we use at Sectra is ‘security by design and by default’, security cannot be effectively added to a product or system afterwards, it has to be within focus from the design of a product throughout the building, testing and deployment of the product,’ he says.

“At Sectra, security architects are involved from the very start of the design of a product, and every development team has a security champion that ensures that security is considered in every aspect of development and testing.”

Åtting goes on to explain the importance of merging clinical and technological ideas – one cannot have a securely designed piece of health tech if there has been no clinical input. Put simply, it would render the technology moot.

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https://businesswest.com/blog/failing-to-prepare-for-cyberthreats-can-prove-costly/

Failing to Prepare for Cyberthreats Can Prove Costly

Into the Breach

 When hackers gained access to a large retailer’s computer network through scam emails to employees, more than 900 store locations were affected, and 2 million customers were impacted before the company was alerted by a security blogger six months later. That led to several class-action lawsuits against the company, attorney generals in multiple states opened investigations, and the affected credit-card companies issued fines.

In another case, a ransomware attack blocked all access to a regional accounting firm’s computer system, and also deleted files. After ransom was paid, it took several days to restore the applications and recover deleted files from a backup. As a result, the firm was unable to meet tax-filing deadlines, causing brand and reputation damage.

Then there was a company that provides technicians to a laptop manufacturer’s repair center. While a young woman’s laptop was in the custody of technicians at the center, her Facebook account was hacked, and several sexually explicit photos were posted to it. She negotiated a quick multi-million-dollar settlement with the laptop manufacturer, which demanded, in turn, that the staffing company compensate it for the privacy breach.

These are only three of many real-life cases detailed by the Hartford Financial Services Group as warnings that companies of any kind and any size are vulnerable to cybercrime.

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https://www.healthleadersmedia.com/innovation/study-validates-telehealth-substance-abuse-treatment-during-pandemic

Study Validates Telehealth for Substance Abuse Treatment During Pandemic

Analysis  |  By Eric Wicklund  |   September 02, 2022

A study conducted by researchers from the CDC, CMS, and NIH found that the use of telehealth and digital health tools to provide medication to people with substance abuse issues and monitor treatment during the pandemic helped improve adherence and lower the risk of a medically treated overdose.

A new study led by the Centers for Disease Control and Prevention finds that telehealth services used during the pandemic to help people dealing with substance abuse improved treatment adherence and lowered the odds of a medically treated overdose.

The study, conducted by researchers from the CDC, Centers for Medicare & Medicaid Services (CMS), and National Institutes of Health (NIH) and published in JAMA Psychiatry, focused on how healthcare providers used medications for opioid use disorder (MOUD) during the pandemic to treat some 175,000 Medicare beneficiaries.

Providers took advantage of waivers enacted during the pandemic to prescribe three medications – methadone, buprenorphine, and extended-release naltrexone - via telehealth and manage care for their patients through a variety of channels, including virtual care and audio-only telehealth (often via a telephone). These waivers are currently scheduled to end when the national public health emergency (PHE) is lifted sometime next year.

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https://arstechnica.com/information-technology/2022/08/newfangled-edr-malware-detection-generates-billions-but-is-easy-to-bypass/

Organizations are spending billions on malware defense that’s easy to bypass

Two of the simplest forms of evasion are surprisingly effective against EDRs.

Dan Goodin - 8/31/2022, 5:04 AM

Last year, organizations spent $2 billion on products that provide Endpoint Detection and Response, a relatively new type of security protection for detecting and blocking malware targeting network-connected devices. EDRs, as they're commonly called, represent a newer approach to malware detection. Static analysis, one of two more traditional methods, searches for suspicious signs in the DNA of a file itself. Dynamic analysis, the other more established method, runs untrusted code inside a secured "sandbox" to analyze what it does to confirm it's safe before allowing it to have full system access.

EDRs—which are forecasted to generate revenue of $18 billion by 2031 and are sold by dozens of security companies—take an entirely different approach. Rather than analyze the structure or execution of the code ahead of time, EDRs monitor the code's behavior as it runs inside a machine or network. In theory, it can shut down a ransomware attack in progress by detecting that a process executed on hundreds of machines in the past 15 minutes is encrypting files en masse. Unlike static and dynamic analyses, EDR is akin to a security guard that uses machine learning to keep tabs in real time on the activities inside a machine or network.

Streamlining EDR evasion

Despite the buzz surrounding EDRs, new research suggests that the protection they provide isn't all that hard for skilled malware developers to circumvent. In fact, the researchers behind the study estimate EDR evasion adds only one additional week of development time to the typical infection of a large organizational network. That's because two fairly basic bypass techniques, particularly when combined, appear to work on most EDRs available in the industry.

 

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https://slate.com/technology/2022/08/kidney-allocation-algorithm-ai-ethics.html

The Kidney Transplant Algorithm’s Surprising Lessons for Ethical A.I.

A more democratic approach to A.I. is messy, but it can work.

By David G. Robinson

Aug 31, 20229:00 AM

This article is adapted from Voices in the Code: A Story About People, Their Values, and the Algorithm They Made, out Sept. 8 from Russell Sage Foundation Press.

In May 2021, I got a call I never expected. I was working on a book about A.I. ethics, focused on the algorithm that gives out kidneys to transplant patients in the United States. Darren Stewart—a data scientist from UNOS, the nonprofit that runs the kidney allocation process—was calling to get my take: How many decimal places should they include when calculating each patient’s allocation score? The score is an incredibly important number, given it determines which patient will get first chance at each donated organ. But still: decimal places? Surely, I thought, this was a technical detail—a question for the experts.

I quickly discovered that I was wrong. The issue was ethical rather than technical, and fascinating: The computers at UNOS could calculate each patient’s allocation score out to 16 decimal places. And in some cases, for patients in very similar situations, the system would need to carry things out to the umpteenth decimal place in order to find a difference between two transplant patients and offer an available organ to one rather than the other.

Given how high the stakes are, why not use all the data you can and be as precise as possible? To Stewart and his colleagues, that approach felt wrong. Past a certain point, these extra digits of precision get so small that they stop describing real medical differences between patients. A tiny difference in the 14th decimal place between Alice’s kidney score and Bob’s doesn’t actually mean that Alice would do better with a transplant. At that point, the score difference may just be a technical pretext for giving the organ to one candidate instead of the other, a reason that may outwardly appear neutral and objective, but is actually arbitrary.

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https://www.healthcareitnews.com/news/sequoia-project-releases-final-qhin-application-it-moves-operational-phase

Sequoia Project releases final QHIN application as it moves into operational phase

The news marks a "major milestone for TEFCA" said National Coordinator for Health IT Micky Tripathi. Sequoia is also seeking stakeholder feedback for its Data Usability Workgroup.

By Mike Miliard

September 01, 2022 09:18 AM

In the most recent of what has been a series of policy releases these past few months, the Sequoia Project on Thursday published some important final documents on the road to TEFCA: Common Agreement standard operating procedures and the application form for Qualified Health Information Network participation.

With the new releases, ONC's recognized coordinating entity for the Trusted Exchange and Common Agreement is "moving into the operational phase of TEFCA," said Mariann Yeager, CEO of the Sequoia Project, in a statement.

"Since the release of the Common Agreement in January 2022, we’ve been working toward hitting our promised timelines while seeking input from the community. The feedback we received has been invaluable as we worked toward finalizing the SOPs and application."

Drafts of these documents were released earlier this summer for stakeholder feedback, and both Sequoia and ONC have modified and updated the documents in response. They are available on the RCE website:

·         Qualified Health Information Network Application.

·         Qualified Health Information Network Onboarding & Designation SOP.

·         Means To Demonstrate U.S. Ownership and Control of a QHIN SOP.

·         Means To Demonstrate U.S. Ownership and Control of a QHIN SOP Questionnaire.

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https://www.healthcareittoday.com/2022/09/01/bringing-econsent-to-the-intensive-care-unit/

Bringing eConsent to the Intensive Care Unit

September 1, 2022

The following is a guest article by Karen Maduschke, Sr. Director & General Manager, Patient Consent at IQVIA.

In the United States alone, 5 million people are admitted annually to intensive care units (ICU), where they receive acute care and monitoring for active emergencies. If they are a fit with the inclusion criteria, many of these patients can be ideal candidates for receiving investigational treatments that may save their lives while providing insights to researchers that could help save the lives of countless future patients.

In acute care settings specifically, the urgency of medical action can be keenly felt by the patient, their families, and their care providers. For this reason, the ability to provide the option for electronic informed consent (eConsent) to join a trial in place of traditional paper-based process plays a pivotal role in quickly enrolling the patient so that they may receive critical intervention as quickly as possible. In turn, eConsent adoption can simultaneously enable better clinical research as well as rapid delivery of potentially life-saving cutting-edge treatments to patients with an immediate need.

The Challenge of Informed Consent in the ICU

Clinical research has long been highly valued within ICUs for researchers and patients. Still, obtaining informed consent to participate in a clinical trial in these scenarios can be challenging. Patients can be admitted to the ICU for any number of reasons, such as a stroke, heart attack, organ failure, infection, or a major trauma. Their need for care is time sensitive, meaning that getting rapid consent to provide potentially life-saving interventions is essential. However, acute care patients are often unable to provide consent on their own – for example if they are unconscious, physically, or mentally impaired – and need a Legally Authorized Representative (LAR) to step in on their behalf. 

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https://ehrintelligence.com/news/post-acute-care-orgs-face-ehr-interoperability-challenges

Post-Acute Care Orgs Face EHR Interoperability Challenges

Post-acute care organizations reported that their EHR products lack the functionality to support interoperability and reporting.

By Hannah Nelson

August 31, 2022 - Post-acute care providers want EHR platforms tailored for their specific area but continue to face interoperability and care coordination challenges, according to a KLAS report.

No EHR vendor has delivered solutions across the entire breadth of post-acute care settings. Typically, organizations offer home- or facility-based care, so purchase decisions are usually driven by one type of care.

MatrixCare has achieved solid adoption across several post-acute care settings and performs consistently well in home health, hospice, and LTC/SNF.

WellSky offers tools for all measured care settings. However, adoption remains very low in some environments, like LTC/ SNF.

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https://ehrintelligence.com/news/onc-hrsa-partner-on-uniform-data-system-interoperability-initiative

ONC, HRSA Partner on Uniform Data System Interoperability Initiative

ONC and HRSA are working on establishing a USCDI+ dataset to advance the interoperability of HRSA’s Uniform Data System (UDS) and improve access to health data.

By Hannah Nelson

August 31, 2022 - ONC and the Health Resources and Services Administration (HRSA) have partnered on a new USCDI+ initiative to align HRSA’s Uniform Data System (UDS) with interoperability standards, according to a HealthITBuzz blog post.

ONC recently launched the USCDI+ initiative to support the establishment of program-specific datasets that will operate as extensions to the existing United States Core Data for Interoperability (USCDI).

ONC and HRSA are working to align the UDS with interoperability standards and transition to patient-level reporting requirements with USCDI.

“We are also establishing a strategic direction aligned with ONC’s Cures Act Final Rule for HL7 Fast Healthcare Interoperability Resources (FHIR)-based exchange to better support the needs of health centers across the country,” ONC officials noted in the blog post.

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https://healthitanalytics.com/news/framework-to-mitigate-bias-in-radiology-machine-learning-models

Framework to Mitigate Bias in Radiology Machine-Learning Models

A new report outlines best practices for mitigating bias in artificial intelligence and machine-learning tools often used in radiology.

By Shania Kennedy

August 31, 2022 - A special report published in Radiology: Artificial Intelligence last week highlighted the practices that can lead to bias in artificial intelligence (AI) and machine-learning (ML) models increasingly used in radiology and provides strategies to mitigate these issues.

The report is the first in a three-part series on the topic. Part one focuses on data handling, part two on model development, and part three on performance evaluation.

In this first installment, the authors state that 12 suboptimal practices occur during the data handling process that can potentially lead to bias. In this report, data handling is defined as “all data-related processes following the initial planning for an ML study up to model development and training.”

Using this definition, the researchers outlined a framework that divides data handling into four steps: data collection, data investigation, data splitting, and feature engineering. Within each step, there are three overarching practices that have the potential to lead to biases, according to the authors.

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https://healthitsecurity.com/news/health-isac-provides-zero-trust-security-guidance-to-healthcare-cisos

Health-ISAC Provides Zero Trust Security Guidance to Healthcare CISOs

Zero trust security strategies can help healthcare CISOs enhance their organization’s security architecture, but not without unique challenges.

By Jill McKeon

August 31, 2022 - When properly implemented, zero trust security strategies can help healthcare organizations bolster their security efforts. However, the sector faces unique challenges surrounding IoT devices and identity and access management that are worth considering when contemplating zero trust in healthcare.

In a new white paper, Health-ISAC provided guidance for healthcare CISOs to help them understand and implement zero trust security strategies.

Zero trust as a concept has existed for more than a decade, Health-ISAC explained, but it has become even more popular in recent years. In 2021, President Biden issued an executive order on the state of the nation’s cybersecurity and called out the importance of zero trust initiatives. Now, federal agencies across the country are rolling out zero trust architectures.

Additionally, a recent report by Okta found that 58 percent of surveyed healthcare organizations had started implementing zero trust initiatives this year, compared to just 37 percent last year. The potential reasons for this uptick in zero trust adoption largely point to the volatility of the current cyber threat landscape. The healthcare sector has had to adapt and embrace innovative methods of securing its systems in order to appropriately counter cyber threats.

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https://www.ajc.com/news/coronavirus/telehealth-healthcare-use-growing-diversifying/JANLWNWY7ZC3ZICWYCU3IDCQ2A/

Telehealth health care use growing, diversifying

By Donovan J. Thomas

31 August, 2022

Barriers to accessing care are being addressed virtually.

When the pandemic forced medical providers to find creative ways to see patients, telehealth provided an answer.

But as the pandemic has receded, telehealth services — which include video chats as well as phone calls — are solving long-standing problems with access to healthcare. It allows patients to see a doctor from wherever they are, increasing access in spite of life’s circumstances.

Dr. Justin Zaghi, chief medical officer at Heal, a company that self-advertises “primary care in the comfort of your home, covered by Medicare” has witnessed telehealth both before and during the pandemic. “Prior to the pandemic, telemedicine was really a miniscule part of the care delivery model,” said Zaghi, whose company expanded operations to Georgia in 2019. “What the pandemic did is that it accelerated the adoption of telemedicine across our practice.”

According to a briefing on national telehealth use in 2021 released in February by HHS, one in four of nearly 700,000 respondents said they had used telehealth services in the previous four weeks. Telehealth use was highest among those under Medicaid and Medicare, Black respondents, and those earning less than $25,000.

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https://consumer.healthday.com/8-29-high-tech-socks-could-prevent-falls-in-at-risk-patients-2657940637.html

High-Tech Socks Could Prevent Falls in At-Risk Patients

Denise Mann

TUESDAY, Aug. 30, 2022 (HealthDay News) -- Every year, anywhere from 700,000 to 1 million people fall while in U.S. hospitals, and this often triggers a downward health spiral.

Little has been shown to make a dent in those numbers. Until now.

Enter Smart Socks, which are wired with sensors that send an alert when a patient tries to get up from a hospital bed and puts pressure on the socks.

In a 13-month study, nobody who wore the socks fell, which equaled a rate of 0 falls per 1,000 patient-days. Patient-days refers to the number of falls and the number of occupied bed days on a hospital unit over a study period. Historically, this rate is 4 falls per 1,000 patient-days.

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https://www.healthdatamanagement.com/articles/new-hl7-community-working-to-ease-the-exchange-of-genomic-data?id=130967

New HL7 community working to ease the exchange of genomic data

GenomeX will devise ways to apply the FHIR standard to enable use of patients’ genomic information for research or treatment.

Aug 29 2022


HDM Staff

HL7 has launched a new effort, GenomeX, to advance the interoperability of genomic data through the use of its Fast Healthcare Interoperability Resources, or FHIR, standard.

The new GenomeX “community” will develop and promulgate ways to use FHIR to improve access to patients’ genomic information. The initiative is a new domain under CodeX.  CodeX is a FHIR accelerator that aims to speed up the development of interoperable data modeling and applications to improve patient care and research in oncology, cardiovascular medicine and, now, genomics.


"The use of FHIR to support data exchange could lead to wider use of genomic data for medical research and easier inclusion of data in electronic health records for precision patient care."

Steve Bratt, leader of health standards and interoperability, MITRE


The use of genomic information in healthcare is rapidly growing as genomic sequencing becomes more widely available. However, the huge amount of data derived from tests is not easily exchanged between testing labs, which primarily use proprietary systems or older HL7 standards, such as HL7 Version 2.

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https://www.healthcareitnews.com/news/southcoast-health-slashes-chf-and-copd-readmissions-rates-telehealth-and-rpm

Southcoast Health slashes CHF and COPD readmissions rates with telehealth and RPM

Remote patient monitoring and visiting nurses, triage telehealth for the ER, boosting behavioral health with telepsychiatry – Southcoast is deep into virtual care.

By Bill Siwicki

August 30, 2022 08:50 AM

Southcoast Health System, based in New Bedford, Massachusetts, has employed a multipronged approach to solving different issues through telemedicine.

THE PROBLEM

While early goals involved keeping care accessible and safe during the pandemic, staff have worked to focus on continuous improvement and adding programs that would build for long-term value in care delivery.

"One of the first telemedicine solutions we utilized involved tele-triage to reduce PPE demands in our emergency departments and ensure patients were directed to the appropriate level of care," recalled Jim Feen, senior vice president and chief digital and information officer at Southcoast Health System. "Patients seen this way showed a variety of symptoms and this method helped decide which cases may be more appropriate for an urgent care setting or perhaps even a referral back to primary care.

"There were automations built within our existing Microsoft Teams platform that allowed for seamless tele-triage screenings to be initiated by triage nurses in our ED," he continued. "We have other use-case scenarios."

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https://www.healthcareitnews.com/news/continuing-evolution-physician-specialist-it

The continuing evolution of physician specialist IT

What do physician group EHRs need to include over the next decade? What are differences between GP and specialist systems that must be considered as the technology evolves? One expert offers advice.

By Bill Siwicki

August 31, 2022 09:44 AM

When meaningful use incentive dollars began being disbursed to specialty medical groups back in 2010, providers quickly implemented new practice management and electronic health record systems.

Fast forward 12 years and specialty practices now are replacing those legacy systems with next-generation platforms. Today, specialty practices are faced with many of the similar "legacy versus new" challenges that hospitals faced a decade ago, but there are lessons learned that practices can pull from to help inform these decisions.

Bill Lucchini is CEO of Nextech Systems, a vendor of EHR and practice management technologies for ophthalmology, dermatology and plastic surgery practices. The vendor serves 4,000 medical practices nationwide.

Healthcare IT News interviewed Lucchini to discuss gaps between legacy EHRs implemented by physician practices and today's technologies. He discussed what EHRs implemented by physician groups need to include over the next decade, and the differences between general practice physician and specialist systems that need to be considered as EHR technology evolves.

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https://ehrintelligence.com/news/new-surescripts-partnership-to-advance-clinical-interoperability

New Surescripts Partnership to Advance Clinical Interoperability

Surescripts will work with Civitas Networks for Health to further its clinical interoperability goals, the health IT vendor stated.

By Sarai Rodriguez

August 30, 2022 - Health IT vendor Surescripts has become a strategic business and technology partner to Civitas Network for Health to drive clinical interoperability for better patient care quality and lower healthcare costs.

Civitas Network for Health supports interoperability through widespread collaboration. The organization comprises member organizations working on using health information exchange, health data, and multi-stakeholder, cross-sector approaches to improve healthcare.

“Civitas Networks for Health is excited to have Surescripts join our national network,” said Lisa Bari, Interim CEO of Civitas. “We are raising the voices of local health collaboratives and those providing critical services to support health transformation.”

“From the secure exchange of life-saving data to the accountability of multi-stakeholder initiatives, our member organizations have built the most trusted, connected, and inventive programs to serve their communities,” Bari stated. “Surescripts has long been a leader in healthcare interoperability, and their partnership is invaluable as we continue improving the delivery of quality healthcare at lower costs to patients.”

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https://healthitanalytics.com/news/experts-call-for-more-randomized-controlled-trials-of-clinical-ai

Experts Call for More Randomized Controlled Trials of Clinical AI

Experts have found a lack of randomized controlled trials evaluating AI-assisted tools integrated into clinical practice, which may impact how researchers quantify the clinical benefit of these tools.

By Shania Kennedy

August 30, 2022 - In a new systematic review published in the Journal of Medical Internet Research, researchers concluded that randomized controlled trials (RCTs) evaluating artificial intelligence (AI)-assisted tools integrated into clinical practice are limited in number and scope and that more of these trials are needed to advance the role of AI in medicine in the future.

There is a growing body of research to support the clinical utility of AI in healthcare, including in chronic disease management, cancer care, and clinical decision support.

However, experts have also raised concerns about its use as its popularity has grown. Some issues arise outside of the technical applications of AI and are related to the data used rather than the algorithms. This is a common challenge for those wishing to apply AI to medical imaging, for example. Other issues stem from the way algorithms are designed, like algorithms that unintentionally perpetuate racial bias.

The issue highlighted in this study belongs to a third category, which is related to clinical readiness and validation of AI models. The researchers here aimed to review all published RCTs of AI-assisted tools to characterize their performance in clinical practice. This information is often used when considering the clinical relevance of these tools, which has the potential to influence the larger role of AI in medicine, according to the study.

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https://healthitsecurity.com/news/ftc-sues-data-broker-condemns-improper-data-privacy-practices

FTC Sues Data Broker, Condemns Improper Data Privacy Practices

The FTC underscored its commitment to fighting against improper location and health data privacy practices in a recent lawsuit against data broker Kochava.

By Jill McKeon

August 30, 2022 - The US Federal Trade Commission (FTC) sued data broker Kochava over its alleged sale of geolocation data, signifying the Commission’s commitment to cracking down on improper location and health data privacy practices after the fall of Roe v. Wade.

The FTC alleged that the data broker knowingly sold geolocation data that could be used to trace individuals to sensitive locations, such as reproductive health clinics, domestic violence shelters, and places of worship.

“The FTC alleges that by selling data tracking people, Kochava is enabling others to identify individuals and exposing them to threats of stigma, stalking, discrimination, job loss, and even physical violence,” the FTC stated in a press release.

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https://www.politico.com/news/2022/08/28/hackers-have-laid-siege-to-u-s-health-care-and-a-tiny-hhs-agency-is-buckling-under-the-pressure-00053941

Hackers have laid siege to U.S. health care and a tiny HHS office is buckling under the pressure

With a dearth of resources, the Office for Civil Rights is struggling with an overflowing caseload.

By Ben Leonard

08/28/2022 07:01 AM EDT

Cyber crooks steal medical information of tens of millions of people in the U.S. every year, a number that is rising fast as health care undergoes its digital transformation.

It leads to millions of dollars in losses for hospitals, insurers and other health care organizations, threatens care delivery and exposes patients to identity theft.

But the Department of Health and Human Services’ Office for Civil Rights, which is tasked with investigating breaches, helping health care organizations bolster their defenses, and fining them for lax security, is poorly positioned to help. That’s because it has a dual mission — both to enforce the federal health privacy law known as HIPAA and to help the organizations protect themselves — and Congress has given it few resources to do the job.

“They’re a fish out of water … They were given the role of enforcement under HIPAA but weren’t given the resources to support that role,” said Mac McMillan, CEO of CynergisTek, a Texas firm that helps health care organizations improve their cybersecurity.

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https://www.healthleadersmedia.com/innovation/new-technology-strategies-improve-occupational-health-management

New Technology, Strategies Improve Occupational Health Management

Analysis  |  By Eric Wicklund  |   August 30, 2022

Health systems are using digital health tools and the electronic health record to not only monitor staff health and track compliance, but give employees an avenue to manage their wellness and connect with supervisors.


KEY TAKEAWAYS

·         Occupational health concerns account for roughly $171 billion in annual healthcare costs and range from illnesses and viruses to behavioral health concerns and substance abuse issues.

·         Prompted in part by the pandemic, which highlighted the importance of monitoring employee health, healthcare organizations are using the EHR platform and digital health technology to track employee health and give staff a platform to manage their wellness and communicate with supervisors.

·         Some health systems and businesses are even using virtual care platforms and wearables to monitor health concerns and give employees on-demand access to care and resources.

Healthcare organizations accustomed to using digital health for clinical care are finding value in these services for occupational health. Some are using technology platforms to help staff track their health and wellness and keep up with testing and vaccination protocols.

Atrium Health Wake Forest Baptist, based in Winston-Salem, NC, is running its occupational health program through a custom-built electronic health platform developed through a partnership with Enterprise Health. The platform gives administrators insight into employee compliance and engagement rates, while streamlining the communication process and allowing interactions through mobile devices and an online portal.

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https://ehrintelligence.com/news/combatting-the-opioid-crisis-through-pdmp-ehr-integrations

Combatting the Opioid Crisis Through PDMP EHR Integrations

PDMP EHR integrations can address barriers to accessing PDMP data to inform clinical practice and improve opioid prescribing, ONC officials say.

By Hannah Nelson

August 29, 2022 - As the drug overdose crisis continues to grow, an interactive tool from CDC and ONC aims to improve opioid prescribing by helping support Prescription Drug Monitoring Program (PDMP) EHR integrations.

“Clinician use of PDMPs is a promising state-level intervention to improve opioid prescribing, inform clinical practice, and support safer and more effective patient care,” ONC officials Lolita Kachay, Jawanna Henry, and Wes Sargent wrote in a HealthITBuzz blog post.

“Integrating PDMP data into EHR systems addresses barriers to accessing and using PDMP data to help inform clinical practice to improve opioid prescribing,” they explained.

The Integration Framework from CDC and ONC provides guidance on project execution, management, and communication for successful integrations and contains the following resources:

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https://www.fiercehealthcare.com/health-tech/amazons-move-eighty-six-amazon-care-strategic-play-not-failure-some-experts-say

Amazon Care shutdown is a strategic play, not a failure, some healthcare experts say

By Heather Landi

Aug 29, 2022 08:06am

Amazon Care may be done, but that's not the end of Amazon's bold healthcare ambitions, industry watchers say.

The online retail giant revealed plans last week to shutter Amazon Care, its in-house business providing virtual and in-person medical services. The business launched in 2019 as a pilot project and then quickly expanded its telehealth services to all 50 states. In-person medical services, typically offered at patients' homes, were offered in seven major cities. Amazon was expected to roll out its hybrid care model to 20 additional cities this year.

"We’ve determined that Amazon Care isn’t the right long-term solution for our enterprise customers," Neil Lindsay, senior vice president of Amazon Health Services, said in an email to employees last week. "Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term."

Lindsay said the decision to end the program had been under consideration for “many months” and that Amazon Care will stop operating at the end of 2022.

Amazon's decision to shut down Amazon Care, which works with about half a dozen employers, comes one month after the company announced a $3.9 billion deal to buy primary care provider One Medical, a company that works with more than 8,000 employers.

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https://www.healthcareitnews.com/news/nurse-ehr-satisfaction-slides-during-pandemic

Nurse EHR satisfaction slides during pandemic

The new Arch Collaborative Nursing Guidebook 2022 contains data on best practices for engaging nurses on EHR mastery.

By Andrea Fox

August 29, 2022 11:27 AM

Electronic health record user mastery by nurses has seen a sharp decline since the beginning of the COVID-19 pandemic, according to researchers. 

WHY IT MATTERS

Nearly 16,000 nurses across 35 healthcare organizations responded to a survey about their EHR experience, with results found in KLAS Research's Arch Collaborative Nursing Guidebook 2022. Those results showed a significant drop, with just 59% of nurses surveyed in 2022 finding ongoing training helpful compared with 71% of those surveyed in 2020. 

The urgency to build user mastery is clear, said KLAS researchers.

Nurses in radiology, pediatric and newborn intensive care units and procedural and behavioral health environments reported struggling with the EHR "and tend to disagree [that] their EHR has the functionality they need," according to the guidebook.

Nurses in these areas would particularly benefit from improved onboarding, ongoing training, inclusion in governance and heightened communication efforts.

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https://www.healthcareitnews.com/news/smartphone-screening-doubled-afib-detection

Smartphone screening doubled Afib detection

The two-stage study compared app-based smartphone with conventional screening and found digital exams superior at detecting atrial fibrillation.

By Andrea Fox

August 29, 2022 03:57 PM

The eHealth-based Bavarian Alternative Detection of Atrial Fibrillation (eBRAVE-AF) trial asked older adult members of one German health insurer to use a smartphone app that measured pulse irregularities using the phone's camera button and then wear a 14-day electrocardiogram patch in order to engage at-risk patients to seek a doctor's treatment. 

WHY IT MATTERS

Afib is the most common heart rhythm disorder and is often hard to diagnose due to a lack of symptoms. 

While previous studies tested the potential of smart devices for large-scale Afib screening, they made no comparison with conventional screening – symptom evaluation, ECGs and other methods – according to the European Society of Cardiology announcement.

The eBRAVE-AF researchers invited adults aged 50 to 90 years old who were at risk for stroke but had not experienced any major adverse cardiac and cerebrovascular events and who owned smartphones to participate.

Participants had no known atrial fibrillation, no oral anticoagulant prescriptions and a CHA2DS2-VASc score (a scoring methodology based on several factors that would increase the risk of stroke) of ≥1 men and ≥2 in women. 

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https://www.healthcareittoday.com/2022/08/29/newest-digital-health-programs-address-digestive-disease-management/

Newest Digital Health Programs Address Digestive Disease Management

August 29, 2022

The following is a guest article by Bill Snyder is CEO of Vivante Health.

More than 70 million Americans suffer from a wide gamut of digestive diseases, but until recently few digital health solutions were available to help them manage their conditions. There are smartphone apps for tracking everything from exercise, sleep and calorie consumption to blood pressure, COVID-19 symptoms and even diabetes management, but gut health has largely been left in the digital dust – in part because there is no one-size-fits-all solution for a category spanning so many different disorders.

Today that’s changing as health tech companies begin to tackle the toll that chronic digestive disease takes on patients, productivity and healthcare costs.

Reducing Medical Spend & GI Symptoms

On the patient side, the havoc wreaked by GI disease includes debilitating effects like nausea, constipation and diarrhea as well as a staggering 8.3 million emergency room visits annually for digestive complaints. (Abdominal pain is the #1 cause of acute ER admissions.)

On the medical spend and productivity side, the toll includes $136 billion in annual medical claims – exceeding the total healthcare bill for trauma, mental health and even heart disease – along with a per-person cost of up to $72,000 in yearly prescription drugs and up to 35 days of absenteeism per year. GI issues are also among the top five healthcare expenses for many companies.

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https://www.healthleadersmedia.com/technology/ftc-files-suit-over-unrestricted-access-digital-health-data

FTC Files Suit Over Unrestricted Access to Digital Health Data

Analysis  |  By Eric Wicklund  |   August 29, 2022

The Federal Trade Commission has filed a lawsuit against Kochava, an Idaho-based digital health company whose data analytics platform can be used to, among other things, identify and track women seeking an abortion and abortion providers. 

Federal officials are taking proactive steps to ensure that data on digital health platforms can’t be used to identify women seeking an abortion.

The Federal Trade Commission is wading into the hot-button issue with a lawsuit filed against Kochava, an Idaho-based provider of mHealth app analytics and attribution. The suit alleges that the company has customized its data feeds to allow interested parties to identify the location and identity of mHealth app users through unique device identification numbers and geolocation data, thereby allowing them to target women visiting healthcare provider offering abortion services.

“Where consumers seek out healthcare, receive counseling, or celebrate their faith is private information that shouldn’t be sold to the highest bidder,” Samuel Levine, director of the FTC’s Bureau of Consumer Protection, said in a press release. “The FTC is taking Kochava to court to protect people’s privacy and halt the sale of their sensitive geolocation information.”

In its complaint, the FTC alleges that the company isn't protecting data from mobile apps and devices, "allowing anyone with little effort to obtain a large table of sensitive data and use it without restriction." Using a week's worth of data collected from more than 61 million mobile users by the company, the agency said it was possible to identify and track people in such sensitive places as reproductive health clinics, places of worship, homeless and domestic violence shelters, and addiction recovery centers.

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https://www.healthdatamanagement.com/articles/digital-patient-communication-reducing-risks?id=130831

Digital patient communication: Tips for reducing your risks

Here’s a list of do’s and don’ts to keep in mind when using texting, email, social media and more to connect with patients.

Aug 11 2022


Wes Morris

Sr Dir, Consulting Svc, Clearwater

Consumers have a growing list of expectations when communicating with companies – and healthcare is no exception.

Many patients expect to have easy access to their personal health information at any time and from anywhere. They demand to gain access in a variety of ways, including via text messages, emails, websites, chats and phone calls.

Unfortunately, some patients may not realize that many of the ways they’re used to communicating in their personal lives are unsafe for sharing PHI.

Healthcare organizations need to understand the potential risks of each communication channel as well as their data privacy and security obligations under HIPAA. Here’s a look at key issues for each channel.

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Enjoy!

David.

Friday, September 09, 2022

It Is Important For Clinicians To Understand Just What Liability They Face When Relying On Clinical Decision Support (CDS) To Determine Treatment!

This appeared a little while ago.

Who is at fault when medical software gets it wrong?

Clinical decision support software is beneficial but if it malfunctions, a doctor’s duty of care likely makes them liable

By Dr Megan Prictor, University of Melbourne

August 4, 2022

Doctors are being increasingly encouraged to rely on digital technology to guide care, but who carries the blame if doctors rely on software that makes mistakes, leading to patient harm?

Imagine this. A patient has recovered enough from a heart attack to be discharged from hospital. The presiding doctor sorts out the discharge using a hospital computer that has clinical decision support software, which compares the patient’s data with inbuilt algorithms to make recommendations for their care.

Clinical decision support tools are increasingly used throughout our healthcare system to promote high-quality care aligning with evidence and guidelines.

In this case, the software generates a pop-up alert recommending that the doctor prescribe a specific medication on the basis that the patient isn’t already taking it. The doctor prescribes the medication, and the patient goes home. A few days later, they die. An investigation finds that the patient had twice the recommended amount of the medication in their system.

It turns out the patient was already taking a dose of this same medication in a tablet that was combined with another drug. As a result, because of the new prescription, the patient had actually been taking a double dose of the medication, which proved to be fatal.

Information about the other medication the patient was already taking was in their medical record, but the clinical decision support tool was flawed – it didn’t recognise the existing medication the patient was on as being in the same category as the newly-prescribed medication.

The doctor was well aware of the rule against combining both medications but had relied on the computer alert. Who is responsible under the law for the patient’s death?

A scenario like this isn’t far-fetched; in fact, it’s based on one story in a recent study of flawed clinical decision support software that led to patient harm.

There is a lot of research showing that clinical decision support software is generally beneficial. For instance, it reduces medication prescribing errors and enhances the chance that doctors will follow guidelines for delivering high-quality healthcare. Yet there is also increasing awareness that malfunctions in clinical decision support software are more common than we think.

The person responsible for the mistake should bear responsibility for the harm. But who, in a situation like this, was really responsible? Was it the software company that created the flawed product and didn’t test it properly? Or was it the doctor, who should have realised the alert was wrong and overridden it?

As a legal academic, I have been working with a University of Melbourne team developing a new clinical decision support tool. I was interested in where a patient would find a legal remedy if they were harmed in this type of situation, and who they could hold accountable.

The doctor could also be harmed in some ways too; for instance, they could face disciplinary action and develop mental health problems. Their job may be at risk.

My newly published research into Australian law has found that most of the legal risk is faced by the doctor and not the software developer. This is because doctors have a fundamental duty of care to their patients, which they can’t delegate to a computer when the computer is only providing recommendations and not independently carrying out decisions.

Clinical decision support software is designed to have a human in the decision-making chain; it’s intended that a doctor will use their own judgment about whether to follow each software alert. As a result, it’s quite likely that the doctor in the story would be found to have acted negligently, breaching their duty of care.

The doctor might also be liable under Australian Consumer Law for not providing services with ‘due care and skill’ (section 60).

More here:

https://pursuit.unimelb.edu.au/articles/who-is-at-fault-when-medical-software-gets-it-wrong

To me the  real takeaway is that the legal researcher finds that when a piece of software’s advice is followed that “Australian law has found that most of the legal risk is faced by the doctor and not the software developer”. I find this a pretty sobering finding and one that should be better known by clinicians.

The research makes it clear the clinician needs to carefully assess any advice offered by a CDS and carefully check the basis on which the advice is based!

Sobering stuff I reckon but not out of line with the view that ultimate responsibly for their recommended treatment!

David.