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."
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
January 27,
2023 - Johns Hopkins University researchers have developed
machine-learning (ML) algorithms that can detect the early warning signs of
delirium and predict which patients will be at high risk of delirium at any
point during an intensive care unit (ICU) stay.
The press
release states that over one-third of patients admitted to the hospital and 80
percent of ICU patients develop delirium at some point during their hospital
stay. Delirium can cause inattention, confusion, paranoia, agitation, and
hallucinations in patients, which can worsen patient outcomes.
ICU delirium
occurs more frequently in older and sicker patients and can lead to prolonged
hospitalization, future dementia, and death, according to the press release.
Anti-delirium interventions, such as care bundles, earlier-than-usual physical
and occupational therapy, and medication changes, can be effective but are not
used on every patient because of limited time and resources and the sometimes
unpredictable needs of these patients.
To address
this, the researchers set out to build delirium prediction models.
KLAS: Infection Control Health IT Streamlines Regulatory Reporting
Many Epic
EHR customers are leaving their best-of-breed infection control health IT and
moving to Epic Bugsy for regulatory reporting, the KLAS report found.
January 27,
2023 - Healthcare organizations are looking to infection control health IT
with strong technical support to help drive meaningful outcomes and optimize
regulatory reporting, according to a KLAS
report.
All five
health IT vendors included in the KLAS report have significantly impacted
respondents’ clinical, reporting, and patient outcomes. The most reported
effect is easy reporting for regulatory agencies. Additionally, respondents for
each vendor said that their solution helps decrease hospital-acquired
infections year over year.
Wolters
Kluwer and Premier stood out for improving
clinical workflows, compliance and quality reporting, and patient outcomes.
Wolters
Kluwer customers were most likely to report that the product has needed
functionality. Respondents also said strong customer guidance helps establish
best practices.
Telehealth May Not Improve Opioid Use Disorder Treatment Quality, Access
A recent
study shows that a higher rate of telehealth use was not linked to increased
access or improved quality of treatment for opioid use disorder patients.
January 27,
2023 - A study published in JAMA Network Open earlier this week found
that clinical outcomes did not vary among opioid use disorder (OUD) patients
receiving treatment from clinicians with high or low telehealth use, with no
evidence showing that telehealth increased access or improved the quality of
OUD treatment.
In this
study, researchers aimed to gather information regarding the relationship
between telehealth use and the treatment of OUD. They conducted a cohort study
that included data from OptumLabs Data Warehouse.
Researchers
included claims for telemedicine visits in both pre-and mid-pandemic periods,
defined as March 14, 2019, to March 13, 2020, and March 14, 2020, to March 13,
2021, respectively. The criteria for inclusion in the study as a patient were
having OUD and enrollment in commercial insurance or Medicare Advantage plans.
Included clinicians were those who provided office-based OUD treatment. The
clinicians were then grouped into low, medium, or high telehealth-use groups.
Huma CEO says UK risks falling behind on digital health
The CEO of
Huma Health, Dan Vahdat, has warned that the NHS risks falling behind countries
including US, Germany and France on adoption of digital health unless it aligns
funding.
Vahdat said
that although the UK rapidly deployed digital health technologies during the
pandemic it had not since followed up with aligning accompanying regulatory
policies and reimbursement regimes.
Talking to
Digital Health News from Davos, the annual meeting in Switzerland of
politicians and global business leaders, where he was speaking on how digital
health companies can help improve health equity, Vahdat said that digital
health has hit the mainstream.
“The Pandemic
required people to do things differently and showed tech can work at larger
scale and can add value. It massively accelerated adoption and 100% that pace
of adoption will be sustained,” the Huma CEO said.
One of the
key differences was that many people hadn’t even been aware that things like
remote consultations were possible three-years ago. “Due to the pandemic
many people have now experienced these services and lots of people love remote
care.”
Artificial intelligence could save
the U.S. up to $360 billion annually if adopted more widely in healthcare,
according to a new report from McKinsey and Harvard researchers.
That’s a big “if,” as AI uptake
has been limited in the industry due to a lack of trust among patients and
doctors, heterogeneous data and misaligned incentives, the researchers
said.
But broader adoption of AI is
likely in the near future, and should also have a slew of non-financial
benefits like better healthcare quality, increased care access and better
patient and doctor satisfaction, according to the paper.
However,
actual adoption of AI-based tools in the healthcare industry is low, despite research
suggesting benefits of the tech.
In
the new paper, researchers estimate that broader adoption of AI could lead
to savings between 5% and 10% in healthcare spending, or roughly $200 billion
to $360 billion a year. The estimates are based on AI use cases employing
current technologies that are attainable within the next five years, without
sacrificing quality or access.
Andrus on
Hudson's memory care residents become more engaged and social using a large
gaming table designed specifically for people with cognitive challenges.
Andrus on Hudson,
based in Hastings-on-Hudson, New York, serves and cares for individuals
("residents," to reflect the environment in which they receive care)
who have various types of dementia. One of the primary challenges caregivers
and residents face are negative behaviors that occur when there are downtimes
during the day and/or the sundown window.
These negative
behaviors include agitation and wandering. While AOH uses best practices to
provide care to these residents, such as responding to those negative
behaviors, it's important for caregivers to expand the "tool kit" for
this special population, said Andruette "Kerry" Beckford, RN,
director of nursing at AOH.
"In addition to
robust recreational therapy programming, tools within the tool kit are
effective, but should be used in moderation, such as having residents watch TV
or similar approaches to help reduce negative behavior," she
explained. "However, these do not always fully engage the resident."
PROPOSAL
To help with the
challenge, AOH turned to Netherlands-based Tover, a healthcare technology
company that focuses on people facing cognitive challenges that include
dementia and intellectual disabilities. Tover markets the Tovertafel, a
gaming table for individuals with cognitive disabilities.
Digital Healthcare Delivery: Four Things That Matter Most
January 27, 2023
The
following is a guest article by Janelle Estes, Chief Insights Officer at UserTesting, a video-based
human insight platform.
In
a world that runs at lightning speed and thrives on instant gratification,
getting in to see a doctor tends to be a painfully slow exception.
On
average, it takes 26 days to schedule a new patient appointment in-office in
large U.S. cities, according to a recent study
by medical staffing firm AMN Healthcare. And that number is rising, up from 24
days five years ago.
No
wonder telehealth adoption is surging.
Development
and innovation in telehealth was already underway in recent years, but usage
skyrocketed during the pandemic as people sought alternatives to in-person
visits and it remains high today. According to a McKinsey report,
telehealth utilization is 38 times higher than before COVID-19.
SDOH
capture can result in improved patient satisfaction scores and reduced provider
burnout.
KEY
TAKEAWAYS
·With increasing attention on population health
and quality initiatives, some organizations have turned their focus on
capturing patients' SDOH.
·SDOH codes are not currently tied to
reimbursement, meaning SDOH capture isn’t on the list of priorities for all
revenue cycle leaders.
·One leader says there are many more
positives to collecting this data other than reimbursement, including reduced
provider frustration and burnout.
The CDC
recently announced 42
new ICD-10-CM diagnosis codes for 2023 effective April 1. Taking the
spotlight for these changes are new codes for reporting certain social determinants
of heath (SDOH).
With
increasing attention on population health and quality initiatives,
organizations have turned their focus on SDOH and how capturing those ICD-10-CM
codes impacts their patient population and their success in caring for that
population.
Capturing
SDOH is critical for revenue cycle teams. SDOH data can provide revenue cycle
leaders with a better understanding of patient populations to inform revenue
planning and strategy.
Technology
and eHealth are an essential part of delivering integrated care as outlined in
Sláintecare – yet the HSE trails behind other countries in its implementation,
an Oireachtas Health Committee meeting heard earlier this week
The
HSE’s technology and eHealth solutions need to be radically overhauled to
provide the standard of care offered by a modern health service, a meeting of
the Oireachtas Health Committee has heard.
“There’s
a long road to go, and other countries are ahead of us,” Fran Thompson, Chief
Information Officer for the HSE, told the Committee earlier this week.
Thompson
explained that the health service is being ‘held back’ with inefficient, and
often paper-based patient interactions. Patients’ outcomes are negatively
impacted by retrograde systems managing their health data: paper-based systems
are more likely to cause clinicians to make mistakes. They also stifle their
ability to share a patient’s data with other healthcare professionals.
January 26,
2023 - Interoperability continues to improve, with 88 percent of hospitals
participating in electronic health data exchange as of 2021, according to
an ONC data
brief based on the AHA Information Technology (IT) Supplement to the AHA
Annual Survey.
Since 2017,
the number of hospitals engaged in integrating patient health data into EHRs
has grown 40 percent, with around three-quarters of hospitals engaging in this
activity in 2021.
Additionally,
rural and small hospitals’ usage of information received electronically from
outside sources increased at twice the rate of hospitals nationally (over 40
percent vs. over 20 percent) between 2017 and 2021.
Rural and
small hospitals’ rates of having patient information available at the point of
care increased by 26 percent from 2017 to 2021, reaching 48 percent.
January 26,
2023 - The UCLA Latino Policy and Politics Institute conducted
a study that shows healthcare disparities linked to telehealth use during the
COVID-19 pandemic resulted from race, age, language, and technology access
barriers.
Restrictions
to in-person healthcare led many patients and providers to use telehealth
services after the COVID-19 pandemic hit. According to the Centers
for Disease Control and Prevention (CDC), 37 percent of adults said they
used telehealth within a year before 2021.
Although
telehealth has served as a valuable resource for many, the UCLA Latino Policy
and Politics Institute found that issues, including language barriers and
insufficient access to technology, often prevented many people from reaping
telehealth's benefits.
Researchers
used data from a Los Angeles County healthcare system for the study. They
analyzed visits that took place between January and December 2020. They also
surveyed 39 healthcare providers from seven health systems between August 2021
and April 2022.
January 25,
2023 - Ransomware remained a primary healthcare cyberattack tactic in Q4
2022, BlackBerry noted in its new Global
Threat Intelligence Report. BlackBerry's Threat Research and Intelligence
team leveraged data collected by its own security solutions between September 1
and November 30, 2022, along with information from public and private
intelligence sources.
Throughout
the 90-day period, researchers observed threat actors using a variety of
tactics, from downloaders to ransomware, infostealers, and remote access
Trojans (RATs). For the healthcare sector in particular, ransomware “still
poses the biggest threat,” the report indicated.
“In the past,
some RaaS groups like Maze indicated they would not attack hospitals, but such
promises cannot be guaranteed,” BlackBerry noted.
“With the
diversity of multiple RaaS groups and the proliferation of affiliate models,
the group that executes an attack may not be the same group that developed the
malware, which makes tracing and attribution a concern.”
The most
popular Trojan used against healthcare was Qakbot, which the Cybersecurity and
Infrastructure Security Agency (CISA) listed as one of the top
11 malware threats of 2021. HHS also released a threat
brief regarding Qakbot in 2020. Qakbot is often delivered via email as
malicious attachments, embedded images, or hyperlinks.
FDA Okays Tidepool Loop App to Help Guide Insulin Delivery
Miriam E.
Tucker
January 24, 2023
The
US Food and Drug Administration (FDA) has cleared the Tidepool Loop, a mobile
application for use with compatible continuous glucose monitors (CGMs) and insulin
pumps to enable automated insulin delivery.
Indicated
for people with type
1 diabetes ages 6 years and up, the app algorithm was developed by the
diabetes startup Tidepool, which
already hosts a cloud-based platform for users to download and review data from
different glucose meters, insulin pumps, and CGM systems. The Tidepool Loop
project arose from patient-led, open-source initiatives, as previously reported
by Medscape Medical
News,to enable interoperability between the devices.
"The
[FDA] authorization of the Tidepool Loop is a huge win for the type 1 diabetes
(T1D) community and is a vital step towards a world where people with T1D can
choose the pump, CGM, and algorithm that are best for them — and have all three
work together seamlessly," Aaron Kowalski, PhD, CEO of the advocacy
organization JDRF, said in a statement.
JDRF
helped support preclinical and clinical research in the development of the Loop
algorithm, along with The Leona M. and Harry B. Helmsley Charitable Trust, the
Tullman Foundation, and partnerships with device makers and donations from the
T1D community.
Tools such as ChatGPT threaten transparent science; here are our ground
rules for their use
As
researchers dive into the brave new world of advanced AI chatbots, publishers
need to acknowledge their legitimate uses and lay down clear guidelines to
avoid abuse.
It
has been clear for several years that artificial intelligence (AI) is gaining
the ability to generate fluent language, churning out sentences that are
increasingly hard to distinguish from text written by people. Last year, Nature
reported that some scientists were already using chatbots as research
assistants — to help organize their thinking, generate feedback on their work,
assist with writing code and summarize research literature (Nature 611,
192–193; 2022).
But
the release of the AI chatbot ChatGPT in November has brought the capabilities
of such tools, known as large language models (LLMs), to a mass audience. Its
developers, OpenAI in San Francisco, California, have made the chatbot free to
use and easily accessible for people who don’t have technical expertise.
Millions are using it, and the result has been an explosion of fun and
sometimes frightening writing experiments that have turbocharged the growing
excitement and consternation about these tools.
ChatGPT can write
presentable student essays, summarize research papers, answer questions
well enough to pass medical exams and generate helpful computer code. It has
produced research abstracts good enough that scientists found it hard to spot
that a computer had written them. Worryingly for society, it could also make
spam, ransomware and other malicious outputs easier to produce. Although OpenAI
has tried to put guard rails on what the chatbot will do, users are already
finding ways around them.
The
big worry in the research community is that students and scientists could
deceitfully pass off LLM-written text as their own, or use LLMs in a simplistic
fashion (such as to conduct an incomplete literature review) and produce work
that is unreliable. Several preprints and published articles have already credited
ChatGPT with formal authorship.
Orlando Health to launch AI-driven hospital-at-home services
The health
system selected Biofourmis, which can analyze more than 120 biomarkers in
real-time, to extend hospital-level care to patients across Central Florida.
Data
from the new hospital-at-home platform will be accessible through Orlando
Health's Epic electronic health records through a multi-year agreement with the
connected health and digital therapeutics company.
WHY IT
MATTERS
Orlando
Health – a non-profit health system with 18 hospitals and emergency rooms with
five in development serving the southeastern United States – is expected to
launch the new advanced remote patient monitoring capabilities in early
2023.
Adding
a virtual provider network can improve patient outcomes, prevent hospital
readmissions, accelerate drug development and closes critical gaps in care,
according to the Bifourmis announcement.
The
data-driven platform takes physiological signal data from patient sensors –
like heart rate, blood pulse wave, heart-rate variability, respiration rate and
numerous others – and applies advanced AI and machine-learning techniques to
flag changes in at-home patient conditions that could indicate disease
progression.
Sheba
Medical Center is focused on using artificial intelligence to turn around
statistics on patient safety.
"In
terms of patient safety, we've made no progress over the past 30 years,"
said Prof. Dr. Eyal Zimlichman, chief transformation and innovation officer at
Sheba Medical Center, which is located on the outskirts of Tel Aviv.
After
seeing a report on these findings, Zimlichman said he and his team realized two
things: It was a huge challenge; and they had "no clue how to handle"
it. Zimlichman, who has also served as the health system's CMO since 2017,
turned to digital health technology to tackle patient safety.
Zimlichman
leads the Accelerate Redesign Collaborate (ARC) Innovation Center at Sheba,
which, with close to 2,000 beds, is among the largest health systems in the
Middle East. ARC is focused on precision medicine, big data, artificial
intelligence, predictive analytics,
telemedicine and mobile health.
Omaha program uses HIE tech to improve postpartum care for minority
parents and children
The
CyncHealth health information exchange for Nebraska and Iowa and its two
partners are being recognized by HHS's Racial Equity in Postpartum Care
Challenge.
CyncHealth,
Collective Medical and Innsena are being recognized by the Department of Health
and Human Services' Racial Equity in Postpartum Care Challenge, including
federal funding of $40,000, for their postpartum care program in Omaha.
Pregnancy-related
deaths are three to four times more common among minorities than among
Caucasian women, even among those with a college degree. This program improves
postpartum care for Black and Indigenous parents and children with high-risk
conditions who participate in Medicaid and the Children's Health Insurance
Program, and significantly reduces maternal and neonatal mortality.
Out
of the 25 winners recognized by HHS, this program is the only one using health information exchange technology to
improve personalized care at the community level.
THE
PROBLEM
"Support
throughout pregnancy and postpartum is critical for creating lifelong health
and wellbeing, physically and mentally, for mother and infant," said Jaime
Bland, CEO of CyncHealth, the HIE. "In the days, weeks and months
following childbirth, women are in a critical time for their care as they
experience physical, social and psychological changes.
New Tool Provides Population Health Insights in US Congressional Districts
The
Congressional District Health Dashboard is designed to provide policymakers and
the public with actionable and nonpartisan health data at the congressional
district level.
January 25,
2023 - Researchers from New York University (NYU) Grossman School of
Medicine and the Robert Wood Johnson Foundation (RWJF) unveiled
the Congressional District Health Dashboard (CDHD), an online data tool that
provides health data for all 435 US congressional districts and the District of
Columbia.
According to
the press release, the tool incorporates 36 critical measures of health and its
drivers, such as deaths from breast cancer and cardiovascular disease, diabetes
rates, housing affordability, and access to nutritious foods. Until now, much
of these data were difficult for the public to access or unavailable at the
congressional district level.
Dashboard
users can explore data on health, poverty, education, and other factors by
congressional district and compare the rates of these metrics among demographic
groups within districts. The tool also enables users to view any district's
snapshot, which shows all 36 measures compared to the national average.
“The
Congressional District Health Dashboard will help fill a critical need for
timely, rigorous, and actionable data that can inform evidence-based
policymaking,” said Marc Gourevitch, MD, chair of the Department of Population
Health at NYU Langone Health and the initiative’s principal architect, in the
press release. “Now, policymakers, advocates, and others can drill down to
their specific congressional districts to identify the opportunities and
challenges affecting the health and wellbeing of all the people they serve,
regardless of income, race, or zip code.”
WASHINGTON –
Spokane’s VA hospital and other medical facilities across the country suffered
a major slowdown Monday and part of Tuesday after an update to a troubled
electronic health record system caused a “performance degradation,” the
Department of Veterans Affairs said Tuesday.
Employees at
Mann-Grandstaff VA Medical Center alerted The Spokesman-Review to the problem.
VA Press Secretary Terrence Hayes confirmed changes made to the system by the
Department of Defense, which shares a database with the VA, “had the unintended
consequence of interrupting services that provide connectivity to the network.”
As a result,
Hayes said in a statement, each time users clicked a button in the system, they
had to wait “long intervals” for the next screen. That further slowed a system
whose clunky design has reduced the number of patients the Spokane hospital can serve
and left employees exhausted.
Hayes
confirmed the slowdown affected every medical facility using the system,
including more than half of all Military Health System providers, as
well as VA clinics and hospitals in Washington, Idaho, Oregon and Ohio. As of
Tuesday afternoon, “configuration changes” had been made to resolve the issue,
he said, adding the VA would “continue to monitor the system and user feedback
to confirm the lag is fixed.”
Men-identifying
Americans are four times
more likely to die by suicide than women-identifying Americans. In the U.S.,
78% of all suicides are committed by men ages 16-64 years.
"They're
really struggling but they're struggling in silence, and it's below the
surface," said Joe Conrad, an entrepreneur and digital health executive.
Conrad,
the founder of Grit Digital Health, helped to launch Man Therapy in 2010, as an interactive
mental health campaign targeting working-age men that employs humor to cut
through stigma and tackle issues like depression. The website is designed to
educate, reduce stigma and encourage men to seek help in times of crisis.
Ten
years ago, the Colorado Department of Public Health and Environment wanted to
find a new way to help men reject the “cowboy-up” approach to mental health.
With billboards trumpeting that “You can’t fix your mental health with duct
tape” and Dr. Rich Mahogany starring in mental health informational videos, the
government saw men of working age seeking treatment for the first time.
Amazon
rolled out a new prescription drug subscription for Prime members called RxPass
that will ship generic medications to customers' homes for a flat monthly fee
of $5.
Prime
members can use the new service to order commonly prescribed generic
medications that treat more than 80 common health conditions, including
high blood pressure and acid reflux, and the service includes free
delivery.
RxPass,
which is available starting Tuesday in most U.S. states, includes 50-plus
generic drugs, according to John Love, vice president of Amazon Pharmacy.
The aim is to provide affordable access to commonly prescribed generic
medications, he said.
"At
$5 a month, you know what you're going to pay for your medications. In most
places, that's less than a mocha or a cup of coffee. This is the starting
list, and we're excited about the coverage that it provides," he said in
an interview.
Pathways
Health Partners, an Accountable Care Organization based in the Central Florida
region, is helping healthcare providers expand access to value-based care.
The
organization currently works with more than 280 providers across multiple
clinical specialties. Pathways supports its providers by enabling more
immediate access to patient records, connected care platforms and new
technological advancements.
In its work
with providers, the ACO recognized the growing need for real-time notifications
and access to patient information to advance value-based care goals. Lack of timely
patient information sharing, regardless of where care is delivered, is a widely
recognized gap in the healthcare ecosystem. It was also a key impetus for
e-notification requirements within the CMS
Interoperability and Patient Access Rule.
To expand the
ACO’s data receipt and sharing capabilities for providers, it pursued three
strategies – connecting to a national data exchange, providing real-time access
to encounter notifications and discharge documents, and enabling mobile device
push notifications. A standards-based notifications system was used to support
these initiatives, resulting in further improvements in patient outcomes for
Pathways providers.
The
collaboration will see five of the biggest health data exchanges in the U.S.
working with the planned Qualified Health Information Network on the
interoperability framework.
eHealth
Exchange this week announced that it will be partnering with the Consortium for
State and Regional Interoperability – comprising the largest nonprofit health
data networks in the U.S. – in its anticipated role as a Qualified Health Information
Network.
WHY IT
MATTERS
As one of the nation's oldest and largest health information networks, eHealth
Exchange brings 13 years of experience to its planned QHIN status under the
Office of the National Coordinator for Health IT's Trusted Exchange Framework
and Common Agreement, or TEFCA.
That
includes linking 61 regional and state health information exchanges and five
federal agencies, enabling exchange across more than two dozen different
electronic health record systems. It supports the secure exchange of more than
14 billion EHR transactions annually.
The
Consortium for State and Regional Interoperability, meanwhile, also gathers
some of the nation's biggest health information, including Contexture, CRISP,
CyncHealth, Indiana Health Information Exchange and Manifest MedEx. Together
those HIEs and their affiliated services connect more than 80 million records
for patients across several states.
Working
together on TEFCA will enable a QHIN with a massive nationwide footprint.
Communication
gaps with recalls of home-use medical devices tops the list of healthcare
hazards in 2023, according to the latest report from ECRI, the nation’s largest non-profit patient
safety organization. Other hazards that made ECRI’s top 10 list of healthcare
hazards in 2023 include: failure to manage cybersecurity risks in cloud-based
clinical systems, defective single-use medical devices, and inappropriate use
of automated dispensing cabinet overrides.
Home
healthcare is a growing trend and the experts at ECRI are concerned that
patients are not receiving safety notices, warnings, and recalls for the
devices they are using. Since devices are sold and distributed to patients
through intermediaries (like hospitals, pharmacies, retailers, payers,
employers, etc.), device manufacturers do not have direct lines of
communications with their end-users. Unlike cars, there is no central database
that ties the current owner with a specific vehicle. As a result, patients may
not learn of safety issues or recalls until months later.
In
addition, the language of the notifications can be confusing. One example,
cited by ECRI, was the recall of continuous positive airway pressure (CPAP)
devices. The recall was initiated in June 2021 and affected 5.5 million
devices. It took months for some patients to become aware of the recall and the
notice was unclear whether it was safe for patients to continue using the
device or what actions they needed to take.
In
a press
release, Marcus Schabacker, MD, PhD, president and CEO of ECRI had this to
say about the communication gap: “Even if patients do receive
notifications, the language may be jargon-heavy and perplexing, and patients
may have difficulty determining whether their device is affected or what to do
about it. Without clear, understandable information about a product recall,
patients cannot accurately assess the health risks and may harm themselves by
continuing to use an unsafe device, or by inappropriately stopping use of a device.”
January 24,
2023 - Regenstrief Institute researchers recently announced the
launch of an eight-point framework
that aims to improve patient matching accuracy through algorithm evaluations.
Connecting
patent records from disparate sources across medical providers or facilities,
known as patient matching, can significantly impact patient care.
Patient
health data is often spread across several EHRs from doctors' offices,
hospitals, and health systems. Healthcare providers must match those files to
get a complete picture of their patient’s health history.
Additionally,
researchers pointed out that one-third of rejected insurance claims are linked
to inaccurate patient identification, costing the US healthcare system $6
billion annually.
More Legal Clarification Needed For Clinical Algorithm Development, Use
Researchers
argue that without further legal clarity, recent directives from the HHS and
FDA around the use and development of clinical algorithms may worsen patient
outcomes.
January 24,
2023 - Researchers explored the intersection of clinical algorithms,
anti-discrimination laws, and medical device regulation in a JAMA viewpoint
published this month, arguing that recent directives from the US Department of
Health and Human Services (HHS) and Food and Drug Administration (FDA) on the
fairness, accuracy, and transparency of clinical algorithms may stifle research
and worsen patient outcomes.
The authors
noted that clinical algorithms include both complex, automated tools, such as
sepsis alert systems, and simpler tools for risk calculation, predictions, and
clinical scoring. These algorithms have the potential to help reduce implicit
biases and medical errors that can occur during clinical decision-making, but
they can exacerbate disparities and impact patient safety if insufficiently
validated.
Currently, no
binding, comprehensive guidelines exist for the development, validation, and
remediation of these algorithms, making addressing biases or inaccuracies
legally unenforceable and voluntary, the authors stated. The FDA and HHS have
recently taken steps toward creating such guidelines, including releasing
new guidance for AI-driven clinical decision support tools and a proposed
rule to update Section 1557 of the Affordable Care Act (ACA), known as
§92.210.
Section 1557
of the Affordable Care Act makes it unlawful for healthcare professionals who
receive federal funding to discriminate based on protected traits, such as race
and sex. The proposed rule would extend these anti-discrimination requirements
to clinical algorithms.
Hyndman Area Health Center cuts IT bill in half with the cloud
It has
experienced a more than 150% increase in patients and has saved hundreds of
thousands of dollars over the past few years since it no longer relies on
physical servers.
Hyndman
Area Health Center – a holistic Pennsylvania-based health center providing
family medicine, dental health, behavioral health and more – transitioned from
client-hosted servers to eClinicalWorks cloud-based servers to expand its
network capacity and meet a rising data demand.
Since
then, it has experienced a more than 150% increase in patients and has saved
hundreds of thousands of dollars over the past few years since it no longer
relies on physical servers.
Healthcare
IT News sat down with Bill Kurtycz, CEO of Hyndman Area Health
Center, to discuss cloud technology, cloud EHRs and telehealth, and how the
technologies have benefitted the provider organization.
Q.
Hyndman Area Health Center delivers, among other things, family medicine,
dental health, pediatrics and women's health. Please talk about the problems
you faced before telehealth and how telemedicine helped overcome them.
A.
Like many healthcare practices, we turned to telehealth during the pandemic.
With so much uncertainty, one thing remained consistent – our patients needed
care. But we didn't know how we were going to triage new patients, if they were
going to come into our facilities, or how we were going to track patients with
existing medical conditions.
Lack of Interoperability Exacerbates Staffing Shortages, Clinician Burnout
Provider
organizations noted poor interoperability as the most common problem they need
help addressing, as it worsens clinician burnout and staffing shortages.
January 23, 2023
- Top healthcare pain points among provider organizations include poor
interoperability and long-term solutions to staffing shortages and clinician
burnout, according to a KLAS whitepaper.
In September
2022, KLAS hosted its sixth annual Digital Health Investment Symposium (DHIS),
bringing together provider organization executives, health IT vendors,
investors, and innovators to discuss health IT developments.
To gather
insights before the symposium, KLAS asked attendees to complete a pre-summit
survey identifying top pain points in healthcare and how confident they feel
addressing those challenges.
In the
pre-summit survey, respondents from provider organizations noted technology
and data siloes as the most common problem they need more help addressing;
none feel confident tackling this issue.
January 23,
2023 - Nearly 80 percent of healthcare data breaches reported to the HHS
Office for Civil Rights (OCR) in 2022 were attributed to hacking and IT
incidents, Fortified Health Security noted
in its “2023 Horizon Report,” signifying a 45 percent increase from just five
years ago.
What’s more,
70 percent of reported breaches (impacting more than 500 individuals each)
affected healthcare providers, with business associates and health plans making
up a much smaller portion of the total number of impacted entities. In total,
51.4 million healthcare records were breached in 2022, compared to 49.4 million
in 2021.
As previously
reported, many of the top
ten largest healthcare data breaches reported to HHS in 2022 stemmed from
third-party vendors, underscoring the need for better third-party risk
management. These trends are likely to continue into 2023 and beyond, Fortified
Health Security suggested.
“Healthcare organizations
must get granular with cybersecurity precautions if they want to stem the tide
of breaches,” the report continued.
Death by 10,000 Clicks: The Electronic Health Record
— Here are a few steps to relieve the burden
by Anthony M.
DiGiorgio, DO, MHA, and Praveen V. Mummaneni, MD, MBA January 21, 2023
Electronic
health records (EHRs), once promised to revolutionize healthcare, are becoming
a burden. We audited the EHR logs at our institution, University of California
San Francisco, to examine the work of our neurosurgery residents and get a
better understanding of the benefits and burdens. The results shocked us: the
on-call residents spent 20 hours opens in a new tab or window
logged into the EHR over a single shift.
When
we shared these results with the residents, they weren't surprised. They feel
that EHR burden every day.
The
Promise and Disappointment of EHRs
The
EHR has plenty of benefits. Gone are the days of hunting for films in the
radiology basement, searching the floors for that missing chart, or deciphering
the infamously bad doctor handwriting. For patients who have a usual place of
care, having quick access to their past records is valuable.
We
considered whether perhaps this busywork had been replaced by more efficient
EHR workflows. To see if this was the case, we examined what tasks the
residents were doing when they were interacting with certain areas of the EHR.
This "active time" (any time they spent moving the mouse or clicking
the keyboard while in a patient chart) totaled 9 hours per shift but excluded
computer activities outside of patient charts, most notably imaging review.
This active time log revealed several inefficiencies, such as a daily average
of 45 minutes spent searching for orders, reconciling orders, and navigating
order decision support tools. This deep dive showed us that the scut work of
old has been replaced with a worse EHR burden.
Microsoft
announced a jarring pivot this week by firing 10,000 employees and moving
resources toward artificial intelligence.
Paige,
the only company FDA-approved for a clinical AI application in digital
pathology, is one enterprise a touting recent partnership with the tech giant.
AI-powered
pathology company Paige announced the partnership last Wednesday, a week before
Microsoft CEO Satya Nadella sent an email to employees
announcing the layoffs, according to a filing with the U.S. Securities and
Exchange Commission. The 47-year-old company is only the latest in a string of
tech giants cutting the fat after accelerating hiring during the pandemic to
meet to demand for online services and the expansion of cloud computing.
“During
the pandemic, there was rapid acceleration. I think we’re going to go through a
phase today there’s going to be some amount of normalization of that demand,”
Nadella said at the World Economic Forum annual meeting in Davos,
Switzerland, yesterday.
This
past year may very well have been the year the "new normal" was
sealed for healthcare – one that includes a lot more telehealth, remote monitoring and other virtual care than ever before.
Technology has became culturally accepted as an integral part of the patient
experience as telemedicine gained popularity.
As
healthcare providers look ahead to 2023, being at the forefront of what's next
in telehealth and strategically integrating the technology necessary to stay
there may be critical to future success.
Trapollo,
a Cox Business company that specializes in telemedicine and RPM technologies
and services, has many insights into why healthcare provider organizations
should prioritize telemedicine offerings and advancements to meet patients
where they are and stay ahead of the competition.
We
interviewed George Valentine, associate vice president, new growth and
development, at Trapollo, to discuss three trends he sees along these lines
becoming very important in 2023.
What's ahead for health IT policy and legislation in 2023
The
government relations team at HIMSS offers some insights on what's next for
telehealth, broadband expansion, interoperability rules and more in the year
ahead.
With
Congress providing telehealth waivers as part of its omnibus spending bill at the close of 2022, delaying the
"telehealth cliff" for two years, HIMSS says it's now ready to make
the case for permanent reimbursement of virtual care.
Also
on its policy agenda for the year ahead: advocating for data standardization,
offering input for interoperability rulemaking and engaging with agencies and
states to increase telehealth access. We spoke with the HIMSS government
relations team for their thoughts on those priorities and more in 2023 and
beyond.
Making telehealth's case for cost control
Telehealth
has proven to reduce burdens on healthcare providers and improve access and has
been a priority for HIMSS for many years, but the Congressional Budget Office
has long complained that all of the data has been for non-Medicare patients,
explained Tom Leary, senior vice president and head of government relations at
HIMSS, parent company of Healthcare IT News.
Budget
leaders have asked, "How do you really know what the impact on the
Medicare population and the Medicare Trust Fund will be? We now have three
years of data on the impact to the Medicare Trust Fund," he said.
Dr
Gordon Caldwell, who has just retired after 40 years as an NHS hospital
consultant, said “horribly inefficient” paperwork around patients moving in
and out of wards is fuelling record delays.
The
senior doctor took a photograph of all the forms required for one medical
admission to an NHS hospital, laid against his 5ft 10in frame.
Dr
Caldwell said promises by the NHS to “digitise” the health service had simply
seen needless bureaucracy transferred on to poor computer systems that were often incompatible with
each other.
The
specialist in general medicine and diabetes endocrinology said: “A few years
ago there were estimates that nurses were spending around 50 per cent of their
time on paperwork; now I’d say it’s closer to 70 per cent.”
“It’s
bureaucratic and it’s very slow and horribly inefficient,” he said.
•Modernise My Health Record to significantly increase the health information available to individuals and their health care professionals, including by requiring ‘sharing by default’ for private and public practitioners and services, and make it easier for people and their health care teams to use at the point of care.
What constitutes ‘health data’? Is there a definition of
‘anonymised’ health data?
Health
data includes:
information or an opinion about an
individual’s health or any health services provided, or to be provided, to
the individual;
any personal information collected
to provide or in providing a ‘health service’ to an individual (including
organ donation); and
genetic information about an
individual that is in a form that could be predictive about the health of
an individual (or relative of the individual).
The
concept of ‘providing health services’ is very broad and can capture a range of
services that may not be front of mind when thinking about health – for
example, information collected by a gym on an individual in connection with a
gym class, or Medicare billing information held by an insurance provider or
debt collector.
Anonymised
health data is not defined, although the Australian Privacy Principles (APP) Guidelines state that
‘anonymity’ means that an individual dealing with an entity cannot be
identified. Critically, health data that may be anonymous in the hands of one
entity may not be anonymous in the hands of another. The ability of an entity
to link a data set with other information is relevant to whether data is truly
anonymised.
Data protection law
What legal protection is afforded to health data in your
jurisdiction? Is the level of protection greater than that afforded to other
personal data?
Given
the sensitivity of health information, its collection, use and management are
regulated by the Privacy Act 1988 (Cth) (the Privacy Act).
Health
data is treated more strictly than personal information under the Privacy Act.
Health data is a subset of ‘sensitive information’ and consent is required for
its collection.
Generally,
an organisation can collect health data from a person if:
the person provides their consent
(express or implied); and
the information is reasonably
necessary for the organisation’s activities.
Implied
consent arises when consent can be inferred from the circumstances and conduct
of the person providing the health information. This is a higher test than that
imposed on other personal information. The Australian government is currently
undertaking a review of the Privacy Act. As part of this review, the government
is considering updating the definition of ‘consent’ to be voluntary, informed,
current, specific, and an unambiguous indication through clear action.
APP
11 requires entities to take reasonable steps to protect personal information
(including sensitive information, such as health information) it holds from
misuse, interference and loss, and from unauthorised access, modification or
disclosure. According to the Office of the Australian Information Commissioner
(OAIC) APP Guidelines, ‘reasonable steps’ will depend on the circumstances
in each particular case and may include governance, culture and training,
internal practices, procedures and systems, information and communications
technology security, access security, and destruction and de-identification.
In
addition, the handling of health information is also subject to certain
state-based legislation, which differs from the Privacy Act in some aspects,
but the differences are relatively minor.
Anonymised health data
Is anonymised health data subject to specific regulations or
guidelines?
APP
2 provides that individuals must have the option of dealing anonymously or by
pseudonym with entities subject to the Privacy Act. However, entities are not
required to provide these options if the entity is required or authorised by
law to deal with identified individuals or if it is impracticable for the
entity to deal with individuals who have not identified themselves. There may
also be practical consequences for patients who do not wish to identify
themselves, as their ongoing healthcare may be difficult for organisations to
manage and they are unlikely to be able to claim a Medicare or health fund
rebate.
De-identification
may be one way to protect the privacy of individuals. De-identification
involves removing personal identifiers (such as name, address, date of birth,
etc) and removing or altering other information that could identify an
individual (such as unique characteristics). However, with the increasing
capability of technology and the sophistication of cyber-attacks, it is
becoming more and more difficult to de-identify data effectively. The
Australian government is currently reviewing the Privacy Act, and considering
increasing the relevant threshold from ‘de-identified’ to ‘anonymous’ (for
information to no longer be considered ‘personal information’).
Types
of de-identified health data include Medicare numbers and healthcare
identifiers. Medicare numbers are primarily used by individuals to claim
benefits under the Medicare Benefits Scheme. APP 9 restricts the use or
disclosure of a patient’s government-related identifier to specific
circumstances (eg, it is reasonably necessary to verify the patient’s identity
for an organisation’s activities).
Healthcare
identifiers are unique 16-digit numbers that identify individual healthcare
providers, healthcare provider organisations (such as digital health
organisations) and individuals receiving healthcare. Healthcare identifiers
help to reduce the potential for mix-ups with health data and are the
foundation for government initiatives such as the My Health Record system, in
which individuals’ health information can be viewed securely online. They are
not health records, but are limited to identifying information such as name,
date of birth and sex to uniquely identify patients. The use of healthcare
identifiers is regulated by the Healthcare
Identifiers Act 2010 (Cth) and Healthcare
Identifiers Regulations 2020 (Cth), which provide that healthcare
identifiers may only be collected, accessed, used and disclosed for limited
purposes (such as providing healthcare, for example, by using it to access the
My Health Record of a healthcare recipient). In circumstances where a
healthcare identifier is used or disclosed for purposes not permitted by the
legislation, criminal and civil penalties may apply.
What are the most
noteworthy rules and considerations relating to the patentability and
inventorship of digital health-related inventions?
Patentees of digital health-related
inventions, which often require computer implementation in one form or another,
need to navigate the patentability requirement in Australia. While abstract
ideas and computer-implemented inventions are not regarded as patentable
subject matter in Australia, patents directed to other aspects of digital
health-related inventions such as hardware, telemetry and diagnostic tools may
be patent-eligible.
Recently, the Full Federal Court of
Australia found that an artificial intelligence system could not be named as an
inventor on a patent application (Commissioner of
Patents v Thaler [2022] FCAFC 62). The High Court of Australia
(Australia’s apex court) declined to hear an appeal of this decision (Thaler v Commissioner of Patents [2022] HCATrans 199).
Patent prosecution
What is the patent
application and registration procedure for digital health technologies in your
jurisdiction?
The Australian patent system provides the
same application process across all technologies, including digital health.
There are no specific provisions for digital health technologies. IP Australia
(incorporating the Australian Patent Office) is responsible for pre-grant
examinations, pre-grant oppositions, re-examinations and amendments to patents
and patent applications. As in other jurisdictions, the process of filing to
grant can take more than 18 months.
Other IP rights
Are any other IP rights relevant in the context of digital health
offerings? How are these rights secured?
Registrable
IP rights are available in the form of design rights that safeguard the visual
appearance of new and distinctive products, such as wearable devices that
incorporate digital health offerings. Design rights are secured through an
application process administered by IP Australia and last for five years
initially (renewable for another five years).
Additionally,
unregistrable forms of IP including copyright, know-how, trade secrets and
confidential information may arise in the context of digital health
technologies and offerings. Contractual measures (such as non-disclosure
agreements) may help to protect the know-how, trade secrets and confidential
information, such as secret algorithms in a digital health app, often in
conjunction with physical and technological security measures. Copyright arises
automatically in some subject matter likely to be integral to digital health offerings,
such as in computer code in a digital health app.
As I browsed through all this I was
reminded just how little I knew about Digital Health law and just how wide the topic
was. If you are in a similar situation this may be a good place to start!
