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ICD-10 Delay: Here We Go Again
APR 4, 2014 10:38pm ET
Timing is everything. On St. Patrick's Day, I wrote a blog about the sobering fact that there were less than 200 days left until the October 1 ICD-10 implementation deadline and that healthcare providers under the gun could be forgiven for indulging in drink. Now, a few weeks later, a crush of events in Washington have turned the ICD-10 compliance deadline on its head, leaving all of us with more questions than answers, particularly concerning what the process will be going forward.
We've been down this road before. This is the second time in nearly two years that the ICD-10 compliance date has been pushed back. However, this time it's Congress, not the Centers for Medicare and Medicaid Services, pulling the trigger. Something feels very different this time around. I know, with the extension of ICD-10 to at least October 2015, the American Medical Association says doctors will now have "much-needed extra year" to prepare for the code switchover. Yet, knowing that human nature is to procrastinate, it doesn't give me any comfort.
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Beth Israel Deaconess cuts readmissions
Posted on Apr 04, 2014
By Rachel Gotbaum, Kaiser Health News/WBUR
Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant federal fines of more than $1 million -- and a lot of soul searching for the staff, says Dr. Julius Yang, the head of quality for the hospital.
“Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,” says Yang.
The hospital was providing quality care to patients when they were in the hospital, but it turned out that focus was too narrow, says Yang.
“In the hospital we provide a lot of structure, we provide a lot of staff. We provide a lot of expertise to manage every moment of their illness,” he says, “but as soon as they leave, the complexity of their situation probably explodes.”
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HHS proposes new HIT software regulation
By AuntMinnie.com staff writers
April 3, 2014 -- The U.S. Department of Health and Human Services (HHS) on Thursday released a report that recommends a new regulatory framework for healthcare IT software.
The goal of the proposed framework is to improve the federal government's regulation of healthcare IT applications by promoting product innovation while maintaining patient protection and avoiding regulatory duplication. The report was developed by the U.S. Food and Drug Administration (FDA), in collaboration with the Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC).
The report proposes a regulatory framework that would divide healthcare IT software into three categories, based on functionality and risk.
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FDA, FCC, ONC Release Risk-Based HIT Regulatory Framework
APR 3, 2014
After months of delays, the Food and Drug Administration, Federal Communications Commission, and the Office of the National Coordinator for Health Information Technology today released a proposed strategy and recommendations for a risk-based regulatory framework for health IT meant to "promote innovation, protect patient safety, and avoid regulatory duplication." Mandated under the FDA Safety and Innovation Act (FDASIA), the draft report to Congress was compiled by the FDA in collaboration with the FCC and ONC.
"The Agencies’ strategy and recommendations for a risk-based framework for health management health IT include four key priority areas: promote the use of quality management principles; identify, develop, and adopt standards and best practices; leverage conformity assessment tools; and create an environment of learning and continual improvement," states the draft report. "The Agencies also recommend the creation of a Health IT Safety Center as a public-private entity with broad stakeholder engagement, that includes a governance structure for the creation of a sustainable, integrated health IT learning system that avoids regulatory duplication and leverages and complements existing and ongoing efforts."
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Nurses Use Personal Smartphones for Care Despite Lack of Support, Security Issues
APR 2, 2014
You may call it a quiet revolution. You may even call it a guerrilla insurrection. Whatever one may call it, nurses in large numbers are adopting the use of smartphones--often their own personal devices--at the point of care, whether their employer supports it or not.
This finding, among others, is a highlight of a new white paper from the Menlo Park, Calif.-based Spyglass Consulting Group. The report is what Spyglass Managing Director Gregg Malkary calls an outgrowth of a similar study performed in 2009. Malkary says the results demonstrate a definite change in attitude among nurses in the past five years.
"Without a doubt," he says. "Nurses are finally stepping up and saying, 'We are tired of being not counted. In fact, because you are not going to invest in us, we are going to take matters into our own hands and use our own personal devices.' That's the real shocker here. We only talk about doctors and BYOD. What about nurses?"
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Redesigned alerts reduce prescriber errors
March 31, 2014 | By Marla Durben Hirsch
Redesigned medical alerts in electronic health records can reduce prescribing errors and provider workloads, and increase user satisfaction, according to a new study in the Journal of the American Medical Informatics Association.
The study, conducted at the Richard Roudebush VA Medical Center in Indianapolis, applied human factors engineering principles to improve alert design for three alerts: drug/drug, drug/allergy and drug/disease warnings. They applied principles used in other industries, such as road sign design and medication labeling, provided more detail in the alerts, and used more concise language, according to an announcement. They then used a simulation study with 20 prescribers and fictitious patients to compare the original versus the redesigned alerts.
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Satisfaction with HIE solutions drops
Posted on Apr 03, 2014
By Bernie Monegain, Editor
Overall provider satisfaction with HIE solutions has dropped an average of 8 percent since last year as provider demands have outpaced vendor delivery, according to a new report from research firm KLAS.
"What is surprising is that despite the millions of dollars HIE vendors invested to add needed functionality, only about half of them are seeing their provider satisfaction scores improve," said report author Mark Allphin, in a news release. "Payment reform and the future of accountable care continue to keep many vendors struggling to keep up with provider demands."
For the report HIE 2014: Revisiting Great Expectations, KLAS interviewed 219 HIE providers, both public and private. Providers gave feedback on three main areas: reliability, relevance and transformation. The HIE products compared are from Allscripts, Cerner, eClinicalWorks, Epic, ICA, InterSystems, Medicity, NextGen, Optum (Axolotl), Orion Health, RelayHealth and Siemens.
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RoI evidence needed for tech strategy
2 April 2014 Lis Evenstad
NHS England’s IT strategy will focus on telehealth, customer service and integrated digital care records, Beverley Bryant has said.
The technology strategy was due to be published in December last year, but was then delayed until March and has now been pushed back until June this year.
Speaking at a Westminster Forum yesterday, the director of strategic systems and technology at NHS England said the reasons for the delay included a lack of evidence about the return on investment that technology could deliver.
Another reason is that NHS England needs to do more work with its stakeholders. “We are not going to develop a tech strategy for just the NHS,” Bryant said.
“If our mantra is integration, our mantra is interoperability; so we need it to speak to all health and care. [That means we need a] bit longer to converse and draw in partners from across the wider care system.”
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ATA's tele-ICU guidelines aim to ensure patient safety
April 3, 2014 | By Dan Bowman
Draft guidance published by the American Telemedicine Association this week focuses on the use of telecommunications technologies in intensive care settings.
The stated aim of the guidance, for which ATA is accepting comments through April 26, is to "assist practitioners in pursuing a sound course of action to provide effective and safe medical care that is founded on current information, available resources and patient needs," according to its authors. What's more, the authors said, the guidelines are meant for tele-ICU services only, and should not be applied to overall ICU care.
"Approximately 13 percent of the nation's adult ICU beds have tele-ICU coverage with a majority of coverage in academic and private hospitals," the authors said, citing a 2013 statistic from the New England Healthcare Institute. "This patient population has the highest cost impact in any organization. The patients are critically ill with many concurrent and emergent needs that occur throughout their ICU stay… By using advanced communication technologies, [tele-ICU] teams are able to leverage clinical expertise across a spectrum of patients in a variety of clinical settings."
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HHS publishes FDASIA framework for health IT
April 3, 2014 | By Dan Bowman
The U.S. Department of Health & Human Services, on Thursday, published the long-awaited proposed strategy and draft recommendations for a health IT risk-based framework mandated by the Food and Drug Administration Safety and Innovation Act.
The 34-page draft report--a collaborative effort by officials from the FDA, the Federal Communications Commission and the Office of the National Coordinator for Health IT--outlines a strategy that identifies three categories of health IT: administrative health IT functions; health management health IT functions; and medical device health IT functions. Risk and corresponding controls, the report's authors said, should focus on the functionality of health information technology, as opposed to the platforms on which that functionality lives.
"The proposed strategy and recommendations reflect the Agencies' understanding that risks to patient safety and steps to promote innovation: 1) can occur at all stages of the health IT product lifecycle; and 2) must consider the complex sociotechnical ecosystem in which these products are developed, implemented and used," the authors said.
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mHealth App Reduces 90-day Readmissions for Cardiac Rehab Patients, Study Finds
April 2, 2014 by Gabriel Perna
Mobile health (mHealth) apps can assist in reducing 90-day readmissions for cardiac rehab patients, a new study from the Rochester, Minn.-based Mayo Clinic reveals.
For the study, researchers looked at 44 patients at Mayo Clinic who were hospitalized following a heart attack and stent placement and divided them into two groups. Roughly, half received a cardiac rehab and the online/smartphone-based program that recorded daily measurements such as weight, blood pressure, minutes of physical activity, and dietary habits. The app also provided patients with educational activities that taught them lifestyle behaviors to avoid further cardiac problems.
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FHA partners with Open Health Tools for CONNECT management
Laura Pedulli
Apr 02, 2014
The Federal Health Architecture (FHA) is partnering with Open Health Tools (OHT) to migrate the governance and code management of CONNECT, an open source software solution that enables secure health information exchange to their open source community.
Through OHT, FHA will implement a governance structure that provides a mechanism for health information exchanges, vendors, providers and academia to expand their contributions to the CONNECT program and have a meaningful voice in its future evolution.
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The benefits of HIE-based PHRs
Source: Logan Haney, Michiana Health Information Network Date: Apr 2, 2014 
Offering personal health record portals through health information exchanges can help providers meet key parts of Meaningful Use and improve patient communications and engagement, while also increasing an HIE's value proposition.
The Michiana Health Information Network is offering patients access to their personal health record through a regional health information exchange serving communities in northern Indiana.
Partnering with The Office of the National Coordinator for Health Information Technology (ONC) Challenge Grant recipient NoMoreClipboard, and one of the nation’s top diagnostic laboratories, the Medical Foundation, MHIN now delivers laboratory results to patients electronically through a Blue Button enabled patient portal.
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ICD-10 Delay Will Hurt Health Care Industry
Thursday, April 3, 2014
While most believe Washington, D.C., is a place riddled with inaction, sometimes things can change overnight.
The rally cry was simple and succinct: There will be no more delays for ICD-10. Only a month ago, CMS Administrator Marilyn Tavenner told attendees at the Healthcare Information and Management Systems Society's annual conference that there would be no delays in moving to the ICD-10-based coding system and that "now is not the time for us to stop moving forward."
All that forward momentum was thrown into turmoil Monday evening, when the Senate voted to approve a short-term solution to prevent cuts to physician payments that would have occurred under the much-maligned sustainable growth rate formula. Included in one section of the legislation is a delay in the adoption of ICD-10 code sets by HHS until at least Oct. 1, 2015.
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ICD-10 delay: canary in the coal mine
Posted on Apr 02, 2014
By Ed Park, executive vice president and COO, athenahealth
The news that someone slipped a provision into the Sustainable Growth Rate patch legislation that will once again delay the transition to ICD-10 is disappointing, and symptomatic of the seemingly unreliable relationship that exists among providers, technology vendors and the government.
Whether the adoption of an already two-decade-old coding system is going to meaningfully transform care is certainly up for debate. But as a proxy for the HIT industry’s ability to handle change on behalf of providers, the latest ICD-10 delay is a troubling canary in the coal mine.
Most of the nation and its healthcare-oriented punditry is correctly focused on the larger issue: the news that Congress has once again failed to solve the ongoing problem of Medicare reimbursements and will once again kick the can down the road another year. We too are disappointed in that development. But while everyone else focuses on that larger issue, policymakers concerned with the tens of billions of dollars that the government has poured into health IT, ostensibly to bring our care delivery system into the 21st century information economy, should not overlook the importance of the latest ICD-10 delay.
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ICD-10: What next?
Posted on Apr 02, 2014
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
After the senate vote on HR 4302, I sent an email to the CIOs of payers and providers in Massachusetts, suggesting that we need to capture the millions spent locally in ICD-10 preparations before mothballing our projects. I suggested that we should continue with testing and go live with as much technology as we can in 2014, minimizing risk to our revenue cycles. Here are some of the responses I received, edited to protect anonymity:
"It would be nice if a couple of us in Mass. could at least say we completed testing and validation and next year we will just regression test."
"I am completely supportive of us maintaining momentum to protect the investments to date. I was also thinking through the ICD-10 transition and potential to down coding to ICD-9 until Oct. 2015. This would require a lot of testing to validate that there is no revenue risks related to the coding conversion. I am not sure if the teams would want to invest the time in that exercise but would support the evaluation process if there is support from coding and finance departments."
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http://www.fierceemr.com/story/himss-analytics-ehr-governance-efforts-lack-doc-engagement/2014-04-02
HIMSS Analytics: EHR governance efforts lack doc engagement
April 2, 2014 | By Dan Bowman
A lack of physician engagement is one of the biggest challenges for electronic health record governance efforts, according to a HIMSS Analytics study published this week.
The study, for which 238 individuals working at healthcare organizations were surveyed, found that 60 percent of respondents have a "formalized EHR governance structure" set up at their facilities. HIMSS Analytics Research Director Brendan FitzGerald, in a statement, said that such structures have the potential to affect incentive program rewards.
"How organizations make decisions around enhancements to EHRs, including implementation, can dramatically impact their ability to meet regulatory measures and create workflow efficiencies," he said.
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Doctors Are Drowning In Data
4/1/2014 09:06 AM
Technology isn't enough to improve healthcare. Doctors must be able to distinguish between valuable data and information overload.
As a doctor, I know the value of information, but I also know what's worse than not enough information: misinformation or too much information. In this information age, we seem to have plenty of both.
No matter what you think or believe, you can find proof of it on the Internet. You can also find a million and one ways to decorate your living room, making it overwhelmingly impossible to decide which ideas to use. The Internet is great at quenching our attention deficits by providing novelty at every click. Indeed, we can spend hours reading, watching, listening, or commenting without accomplishing anything at all. On the other hand, we get access to excellent resources and minds, beyond what was possible in a non-connected world.
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AHIMA pushes standards for cut-and-paste
By Bernie Monegain, Contributing Editor
The use of copy-and-paste should be permitted only when such "strong technology and administrative controls," are in place, the organization wrote in a position statement on Monday.
"Users of copy and paste – reproducing text or other data from one source to another destination – should weigh the efficiency against the potential risk for creating inaccurate, fraudulent or unwieldy documentation," wrote AHIMA, which represents more than 72,000 health information management and health informatics professionals.
In its statement, AHIMA called on government and private organizations to work together in implementing its recommendations to address recent concern about the potential for fraud and inaccuracy in EHRs.
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Big data doesn't have to be 'Star Wars'
Posted on Apr 01, 2014
By Mike Miliard, Managing Editor
When it comes to hacking through the hype of big data, there are two types of analytics projects: those boundary-pushing advancements that, where they do exist, are mainly the product of big hospitals and academic medical centers, and humbler, more doable – but sometimes just as valuable – insights that can be gleaned by smaller providers.
"That demarcation between what's practicable and what's 'Star Wars' is a good one," says John Hoyt, executive vice president of HIMSS Analytics. "When we do our Stage 7 validations, we do not ask for 'Star Wars,'" he says, referring to the seven-step HIMSS Analytics EMR Adoption Model.
Clearly, some hospitals are better prepared than others to make big strides with big data. HIMSS Analytics figures show that 51.03 percent of hospitals are automated with financial business intelligence tools, while 45.8 aren't – and don't immediately plan to be. The numbers are roughly similar for data warehousing/mining technology (52.53 and 44.02 percent, respectively).
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Care.data advisory group meets
1 April 2014 Rebecca Todd
The care.data independent advisory group held its first meeting last week and includes representatives from MedConfidential and Healthwatch.
EHI reported last month that the group had been created and is being chaired by Ciaran Devane, chief executive at Macmillan Cancer Support.
An update provided to the Health and Social Care Information board meeting this week says it includes representatives from professional and citizen groups including the British Medical Association, Healthwatch, the Association of Medical Research Charities, the British Heart Foundation, Big Brother Watch and MedConfidential.
MedConfidential co-founder Phil Booth told EHI he hopes the group will address many “significant issues” with the programme over the next six months.
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Report: Global Healthcare IT Market to Reach $66B by 2020
April 1, 2014 by Rajiv Leventhal
The global healthcare IT market is projected to reach $66 billion by 2020, driven by streamlining clinical workflow processes, according to a new report from market researcher Global Industry Analysts (GIA).
In the report, “Healthcare IT: A Global Strategic Business Report,” GIA says that projection is driven by strong emphasis on improving profitability of healthcare institutions, increasing demand for quality healthcare services, and growing acceptance of mHealth and eHealth practices.
Backed by numerous benefits, increasing number of healthcare facilities are adopting healthcare IT solutions and systems. Growing complexity of healthcare operations, government initiatives to promote IT in hospitals, the shift towards a paperless environment, and the proliferation of smart devices are spurring demand for healthcare IT systems, the report found.
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Report: Data Sharing Cuts Unnecessary ED Visits by 10%
A new report from the Washington State Health Care Authority shows a data-sharing initiative among emergency departments in Washington has reduced ED visits by Medicaid patients by 10 percent in the program's first year.
In Washington, as in other states, patients often visit the hospital ED for conditions that may be more effectively treated in an alternative and less costly setting. To address this issue, starting in the summer of 2012, Washington required hospitals to adopt the Emergency Department Information Exchange database to track patients' ED visits.
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Survey: Smartphone systems for nurses poised for big growth
Hospitals are starting to get serious about implementing enterprise-level, smartphone-based systems for nurses, according to a study by Spyglass Consulting. In a survey of 100 tech savvy nurses from around the country, half said their hospital was now evaluating such an offering. Only 4 percent had actually implemented them already.
Enterprise mobile systems are applications that include (and go beyond) secure messaging for nurses as a replacement for pagers, nurse call systems, and unsecured texting, which is a violation of HIPAA. Messages sent through an enterprise system can also be stored in the electronic medical record. The systems can also be integrated with biomedical monitoring devices to alert nurses automatically if a patient’s vitals drop.
“I think this market is ready to absolutely explode,” said Gregg Malkary, Founder and Managing Director of Spyglass Consulting. “The smartphone has been underutilized in healthcare within acute care facilities. We haven’t even realized the potential of the smartphone to support nursing workflow, or to support clinical workflow as a whole.”
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Why Paper Prescriptions Are Going The Way Of Snail Mail
March 30, 2014 9:21 AM
Charlie is like a lot of my patients. He's in his late 50s, weighs a little too much and his cholesterol and blood pressure are both too high. To lower his risk of a heart attack or stroke, he takes daily pills to control his blood pressure and lower his cholesterol.
A couple of times a year, Charlie visits me to make sure the drugs are working and aren't causing problems.
Caring for patients like Charlie has become easier in the last few years because of something that you might take for granted in 2014: electronic prescribing.
When Charlie needs a new medicine or a refill of an old one, I send the prescriptions to his pharmacy right from my computer — the same one that has replaced the paper medical records we used to use. My ability to prescribe his medicines electronically is a bright spot in what has been a to computerization in health care.
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HIE Helps Integrate Behavioral and Physical Health Care, but Hurdles Remain
Tuesday, April 1, 2014
Although health care providers have long recognized that many of their patients have both behavioral and physical health needs, behavioral and physical health care have long been provided -- and paid for -- separately. However, in light of growing awareness of the prevalence and cost of comorbid behavioral and physical health conditions and increased recognition of how addressing those conditions in a coordinated manner can improve outcomes and reduce costs, the health care system is increasingly embracing care delivery models that integrate behavioral and physical health care and connect providers of such care to one another.
Electronic health information exchange can help facilitate the integration of behavioral and physical health care. However, federal and state strategies are necessary to address common barriers to HIE.
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Latest ICD-10 Delay Re-shuffles the Deck, Irritates Players
Scott Mace, for HealthLeaders Media , April 1, 2014
Another year-long delay in the deadline for implementation of the ICD-10 medical coding set spells frustration for vendors and providers. "This is bad," says CHIME president and CEO Russ Branzell.
CHIME president and CEO Russ Branzell's mood was one of irritation Monday evening in the wake of the Senate "doc fix" vote which postpones ICD-10 compliance requirements for another year.
"We'll continue to try to push to see with the executive branch and the White House staff [Tuesday] to see if there's any chance at all of doing some education of why this is bad. But at this point, we generally think it's going to go through," Branzell told me.
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NIST Seeks to Better Integrate EHR into Clinical Workflow
MAR 28, 2014
Recognizing that issues with workflow integration have contributed to slow rates of electronic health records adoption in healthcare settings such as ambulatory outpatient care, the National Institute of Standards and Technology has issued a report on integrating EHR into clinical workflow with recommendations for developers and outpatient care centers.
The recommendations for improving workflow integration with EHRs are meant to increase efficiency, allow for better eye contact between the physician and patient, improve physician’s information workflow, and reduce alert fatigue. In addition, the recommendations cover scenarios such as supporting tasks accomplished over multiple interactions with an EHR by multiple users, for example, a nurse practitioner drafting medication orders that are verified and completed by a physician.
In putting together their report, NIST used "two human factors workflow modeling tools, process mapping and goal-means decomposition" to collect, visualize, and document insights and end-user needs to improve EHR workflow for clinicians in outpatient care settings. The report identifies clinical activities that "require more relevant and flexible workflows in EHR designs to support end users’ needs" and provides process map visualizations and a goal-means decomposition diagram.
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Healthcare's digital IQ gets assessed
Posted on Mar 31, 2014
By Erin McCann, Associate Editor
A new report highlighting the correlation between digital technology and company performance or profitably spanning 11 different industries underscores a few surprising things about the healthcare sector and its digital IQ.
Nine out of 11 industries rated cybersecurity top of mind for technology investments on which to focus. The healthcare sector, however, was one of two industries that did not consider cybersecurity as being in their top five strategic technologies concerns, according to the new PwC Digital IQ Survey released last week.
Data mining, private cloud, mobile apps, social media and digital delivery of services, however, did prove top of mind for healthcare executives.
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David Harlow: Evidence-based medicine's promise lies in data analyses
March 31, 2014 | By Ashley Gold
Everyone has a digital footprint as a patient, according to Boston-based health attorney and FierceHealthIT Editorial Advisory Board member David Harlow (pictured). When that data is aggregated with the digital footprints of others, it can be usable information, he writes in a recent post for iHealthBeat. The promise of evidence-based medicine, he says, is in the analyses of such data.
Still, Harlow says, health privacy laws and HIPAA remain primary barriers to the free flow of such information and therefore, its insights--and with good reason. He quotes Google co-founder Larry Page, speaking in a recent TED talk, who promoted the notion that health data should be shared for common good; Page proposed the idea of making anonymous health medical records available to doctors for research.
"Yes, Larry, it would be amazing," Harlow says. "But many folks out there are concerned that even de-identified [anonymized] data may be re-identified."
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Study: Tele-ICU tools worth the investment for hospitals
March 31, 2014 | By Dan Bowman
Despite the high cost of implementing telemedicine technology in intensive care units, hospitals could benefit more from such tools both financially and in terms of the quality of care delivered, according to research recently published online in the journal Telemedicine and e-Health.
For the study, researchers from Marshall University reviewed literature and case studies published in the U.S. between 2003 and 2013 that focused on the impact of telemedicine use in hospital ICUs; a total of 55 references were examined. They concluded that while tele-ICU technology could cost as much as $100,000 per bed, significant decreases in total ICU costs, patient mortality rates and length of stay likely outweighed that expense.
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Enjoy!
David.
