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."

Saturday, October 31, 2015

Weekly Overseas Health IT Links -31st October, 2015.

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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Is healthcare IT ready for Baby Boomers coming of age?

Posted on Oct 23, 2015
By Bernie Monegain, Editor-at-Large
People over the age of 60 are likely to be driving the healthcare market around the world in less than five years, according to global research firm Frost & Sullivan.
By 2020, Frost & Sullivan estimates 22 percent of the world's population will be age 60 or older. In order to encourage independent living, IT service providers need to support the development of smart homes and communities that leverage technology-based solutions for the aged, researchers conclude.
The report identifies three anticipated market trends that could help aging people participate in their healthcare:
  1. High adoption of remote monitoring devices, which are useful for personal physicians, nurses and family, will help all senior citizens who prefer to stay in their own homes.
  2. Information and communication technology-based assistive technologies, including computer-based or other electronic communication aids, object locators and reminder systems, will also gain traction.
  3. Employing robots as a support system will emerge as an excellent aged care model.
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Geisinger's Alistair Erskine: How we're using FHIR to create EHR-agnostic applications

October 23, 2015 | By Dan Bowman
When it comes to the widespread use of the Fast Healthcare Interoperability Resources (FHIR) standard, Geisinger Health System Chief Clinical Informatics Officer Alistair Erskine calls himself impatient but optimistic. Erskine has helped Geisinger to develop a number of applications that take advantage of FHIR and public application programming interfaces to be able to exchange information with multiple electronic health record systems, but he'd like to see more.
"I think we need some real world examples, both of an implementation within a particular organization, but also of an app store for healthcare that would be vendor neutral and agnostic," Erskine told FierceHealthIT at last week's College of Healthcare Information Management Executives fall forum in Orlando. "The latter would have a mechanism to curate these apps, make sure they do what they say they'll do and be able to distribute that to the people who want to be able to consume them."
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EHR Use Ups Some Outcomes After Myocardial Infarction

Last Updated: October 22, 2015.
For patients with acute myocardial infarction, electronic health record implementation is associated with some improvement in outcomes, according to a study published online Oct. 20 in Circulation: Cardiovascular Quality and Outcomes.
THURSDAY, Oct. 22, 2015 (HealthDay News) -- For patients with acute myocardial infarction (MI), electronic health record (EHR) implementation is associated with some improvement in outcomes, according to a study published online Oct. 20 in Circulation: Cardiovascular Quality and Outcomes.
Jonathan R. Enriquez, M.D., from the University of Missouri in Kansas City, and colleagues examined the correlation of EHR use with quality of care and outcomes after MI. They compared outcomes for patients treated at hospitals with a fully-implemented EHR (43,527 patients), partially-implemented EHR (72,029 patients), and no EHR (9,270 patients).
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Medical Websites Targeted By 26% Of All Malware In 2015, Digital Assault On Healthcare Ramps Up

By Jeff Stone @JeffStone500 j.stone@ibtimes.com on October 22 2015 12:11 AM EDT
It’s never been more dangerous to visit a healthcare-related website. From insurance companies to self-help websites, hackers launched more attacks on the health industry than any other over the first half of 2015.
That’s according to a report published Thursday by G Data, the German cybersecurity company that regularly tracks cybercrime. This report, the first of two scheduled on malicious software activity in 2015, determined that 26.6 percent of all malware attacks were aimed at health sites. Compare that to 10.2 percent in the second half of 2014 and 6.5 percent in the first half of 2014.
“It could be insurance fraud,” said Andy Hayter, security evangelist at G Data, when asked about the possible motivation for the attacks. “This means people are hacking websites so that when you go there, you’re actually being redirected to a key logger or something that’s collecting information on you. … Healthcare websites are becoming more evil in the past year than they ever have before.”
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We've Spent Billions to Fix Our Medical Records, and They're Still a Mess. Here's Why.

Digitizing America's medical records was supposed to help patients and save money. Why hasn't that happened?
By Patrick Caldwell |
Nestled in the gently rolling hills of Verona, Wisconsin, a small Madison suburb, is the 1,000-acre "Intergalactic Headquarters" of Epic Systems, the multibillion-dollar company that claims its software manages medical records for 179 million Americans—or 56 percent of the country. Epic's HQ features a conference room tucked in a tree house. There's a Dungeons & Dragons-themed building with a moat and a replica drawbridge. One corridor is modeled to resemble a New York City subway car, complete with a statue of a homeless guy asleep on a bench. A group of Harry Potter-inspired office buildings dubbed the "Wizards Academy" is currently under construction.
Judith Faulkner, Epic's 72-year-old founder and one of just 18 women on Forbes' list of self-made billionaires [1], often dresses in costume (Lucille Ball, a Hogwarts wizard) at the company's annual meeting, which draws thousands of hospital executives and IT officers to the company's 11,400-seat Deep Space Auditorium [2]. Her motto: "Do good. Have fun. Make money."
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Vendor gag clauses impede health IT patient safety research

October 16, 2015 | By Marla Durben Hirsch
Electronic health record vendor contracts must be changed to allow for more examination of patient safety without researchers having to worry about obtaining vendor permission or gag clauses affecting their work, according to a new post by Kathy Kenyon, a former project officer with the Office of the National Coordinator for Health IT, in the Health Affairs Blog.
Kenyon states that much of the attention on gag clauses barring physicians from complaining about their systems is misplaced; the real problem, she says, is gag clauses that stifle research. Those gag values, which are related to confidentiality and intellectual property terms, are unclear and overbroad.
EHR design and usability have long been determined to have an impact on patient safety. Vendor contracts, however, have hindered efforts to learn more and resolve the problem.
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Shared EHR access between docs, pharmacists can improve communication, workflow

October 19, 2015 | By Marla Durben Hirsch
Providing pharmacists with access to a physician's electronic health record can improve efficiencies and communication between them, according to a new study in the American Health Information Management Association's Perspectives in Health Information Management.
Much physician-pharmacy interaction for information, such as medication adherence and prescription verification, is handled by fax or telephone, which are both inefficient and distracting. In an effort to improve the flow of information, a supermarket chain pharmacy approached a nearby physician's office to discuss medication therapy management to reinforce the physician's care plans and reduce questions about prescriptions from the pharmacy. 
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Can Watson mine Facebook to spot a concussion?

Posted on Oct 22, 2015
By Eric Wicklund, Editor, mHealthNews
IBM is partnering with Triax Technologies to potentially harness its supercomputer for identifying head injuries on social networks.
The companies are working to embed Watson natural language capabilities into a smart impact sensor headband that Triax offers. 
Triax is among a number of companies working with wearable sensors to combat and treat concussions, which comprise the vast majority of the 3.8 million sports-related head injuries per year.
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Hospitals double-down on supply chain technology to cut costs

October 22, 2015 | By Susan D. Hall
Hospitals are taking a page from retail and other industries by expanding use of technology to cut costs in their supply chains, according to an article in The Wall Street Journal.
In retail, for instance, once a customer scans an item at checkout, the supply chain system automatically tracks that change in inventory. In contrast, hospitals have often relied on counting or guessing estimates for their inventory levels with a range of employees handling products, according to the article.
At BJC HealthCare, which operates a network of 12 hospitals in Illinois and Missouri, expanded use of radio frequency identification (RFID) tags helps hospitals track medical devices and new orders, and lend supplies to other facilities. Those tags send information to a main database that can track if items expire. The system has helped the organization reduce the required stock kept on hand by 23 percent in tests, according to the health system.
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Barcoded medicines to prevent fake drugs

Thomas Meek
19 October 2015
New European regulations mean that all prescription medicines will need to carry a barcode on their packaging to reduce the risk of counterfeit and unsafe drugs entering the healthcare system.
Earlier this month, the European Commission formally adopted the delegated act on safety features for medicinal products for human use, which implements some of the requirements of the Falsified Medicines Directive – legislation that came into force in January 2013 to ensure the safety of medicines.
One of the measures of the Falsified Medicines Directive when it was passed was an “obligatory authenticity feature on the outer packaging of the medicines” that would be decided at a later stage via a delegated act.
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Pharmacy fined for selling patient data

Thomas Meek
21 October 2015
An online pharmacy part-owned by Emis Health faces a £130,000 fine after it sold customer details to a direct marketing company.
An Information Commissioner's Office report says that information from 21,500 patients who used the Pharmacy2U service had been offered for sale through Alchemy Direct Media during November and December 2014. 
These details were purchased by several companies, including Healthy Marketing, a mail-order health supplements company that the ICO said has been cautioned for an advertisement that contained unauthorised health claims. 
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Record sharing: TPP and Emis integrate

Thomas Meek
21 October 2015
England’s two major GP clinical system suppliers are about to begin trialling a direct integration between their systems to allow GPs to share patient records more easily.
TPP and Emis are working with Central London Community Healthcare NHS Trust and NHS Waltham Forest Clinical Commissioning Group on two pilots that will allow users of Emis Web or TPP’s SystmOne to view data stored on the other system without the need for an external integration service.
The pilot at Central London Community Healthcare will allow the trust’s rapid response team, which uses the SystmOne Community module,  to view data in real-time from GP practices using Emis Web. The pilot at Waltham Forest will see records shared between a SystmOne GP practice and an extended hours service using Emis Web.
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EHR vendors sign on to interoperability measures, reporting

Beth Walsh
Oct 21, 2015
Twelve EHR vendors have agreed to adopt a set of metrics and conduct ongoing reporting in an effort to further interoperability.
The consensus occurred at the KLAS Keystone Summit in Utah. The vendors "proactively stepped forward to have an independent entity publish transparent measures of health information exchange that can serve as the basis for understanding our current position and trajectory," according to a statement issued by the research firm. "Assisted by leading provider organizations and informatics experts, these executive officers knocked down barriers to arrive at measures to improve interoperability for the public good. Vendors and providers willingly committed to go arm in arm to work closely with Washington to help alleviate the interoperability-measurement burden faced by the government."
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Telehealth, Online Programs Could Boost Access to Needed Mental Health Care

by Lisa Zamosky, iHealthBeat Contributing Reporter Thursday, October 22, 2015
Technological tools used to diagnose and treat mental health issues may help to offset barriers that continue to prevent millions of Americans from getting the care they need.
Nearly 60% of adults with a mental illness fail to get treatment each year, according to the National Alliance on Mental Illness. The use of telemedicine is proving to be an effective way to reach underserved groups, as well as to improve care coordination and connect people to peer support. Although use of this technology is not yet widespread, the market is growing.
According to the American Psychological Association's Center for Workforce Studies, practitioners' use of videoconferencing with clients increased from 2% in 2000 to 10% in 2008. Further, consumers increasingly are tapping into a range of mobile applications designed to screen for anxiety and depression, manage stress, gain on-the-go access to self-help resources and help people with suicidal thoughts seek help. Other tools help people track their mood and share the information they capture with their health care providers. And apps, like the Department of Veterans Affairs' PTSD Coach, help people manage symptoms that are common after experiencing a trauma.
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Analytics Grow in Maturity, Show Quantifiable Results

OCT 21, 2015 7:42am ET
Healthcare analytics approaches are growing in maturity, helping providers achieve savings and efficiencies in a variety of areas, ranging from cutting supply acquisition costs to helping them analyze which patients need specific types of care.
At the Tableau Conference in Las Vegas on Tuesday, several providers offered insights on their initiatives and spelled out some of the early successes of their efforts.
Savings on supply procurement is a key strategy at BJC Healthcare, a St. Louis-based healthcare system. Lynn Kersting, its strategic manager of supply chain analytics, said the organization is aiming to centralize purchasing and use analytics to reduce supply spending to 19 percent of total revenue, from current levels of about 23 percent.
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Fareed Zakaria: Health IT is no magic bullet

Posted on Oct 21, 2015
By Bernie Monegain, Editor-at-Large
As Fareed Zakaria sees it, the remedy for America's ailing and expensive health system is clear.
It might be hard for some to swallow, but, in his view, it is sure and proven.
"There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It's absolutely clear that is the only way you can achieve that goal," Zakaria said. "The revolution that's needed here is not an information revolution, it's a political revolution."
Zakaria is a journalist, author and host of Fareed Zakaria GPS, a Sunday morning staple on CNN that delves into global issues and ways to solve them. For purposes of his broadcast "GPS" stands for Global Public Square.
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New views of VNAs

In England, vendor neutral archives tend to be associated with digital imaging. But with appropriate standards in place, they can be used for many other kinds of record. And that’s leading to a lively debate about their future; both within trusts and within wider health economies. Kim Thomas reports.
When trusts began procuring new picture archiving and communications systems two years ago, as their National Programme for IT contracts came to an end, many also decided to purchase vendor neutral archives.
VNAs offered a good way of keeping a permanent archive of radiology images, enabling trusts to have a relatively painless transition when the time came to switch contracts or even vendors.
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KLAS interoperability report examines what providers, vendors are doing to connect

October 20, 2015 | By Katie Dvorak
Poor vendor coordination, trouble finding records and limited parsing abilities are among the biggest barriers to interoperability of health information, according to a new study from KLAS.
When it comes to interoperability, providers want "invisible, effortless connections that provide high patient care value," a report summary states.
The Orem, Utah-based research firm interviewed more than 200 healthcare providers over three months for its inaugural study, according to an announcement. KLAS scored electronic medical record vendors on a 1 to 5 scale based on the report's findings.
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Report: HIEs failing to capture impact on quality of care

October 20, 2015 | By Susan D. Hall
Most backers of health information exchanges believe they are improving care and generating a positive return on investment, but few of the exchanges actually offer up data to confirm those beliefs, according to a study published at Perspectives in Health Information Management.
The study is based on data from 35 community HIEs initiated in November 2013, as well as questions posed to people familiar with the exchanges. While two-thirds reported a positive ROI, one-fourth or fewer respondents reported using metrics to calculate ROI. In addition, 76 percent did not deliver reports on quality measures and 73 percent were not using data to measure quality performance of participating providers.
"Our study shows that calculating ROI for HIEs, or their impact on quality of care, remains a secondary priority for most HIEs," the authors state. "These findings, taken in combination with the ending of HITECH funding, raise serious questions about the future sustainability of HIEs, and what form they will take."
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Digital Health Tools Could Save Healthcare System $10B Annually

October 19, 2015
by Heather Landi
The use of virtual health solutions in primary care could save $10 billion annually when applied to annual patient visits, ongoing patient management and self-care, according to a recently released report from Accenture.
The report highlights that the U.S. is faced with health professional shortages, with a projected shortage of as many as 31,000 primary care physicians (PCPs) by 2025, according to the American Association of Medical Colleges. And, the U.S. spent $2.6 trillion on healthcare in 2010, with wages accounting for more than half of that cost.
The Accenture report states that combining virtual health and traditional patient care models can help address the nation’s clinician labor cost and capacity challenges.
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Technology Support for More Transparent Hospital Pricing -- It's Surprisingly Complicated

by Doug Thompson and Shelly Yu Tuesday, October 20, 2015
Today's competitive, consumer-driven environment requires health care providers to gain patient loyalty through service excellence. Price transparency represents one way providers can give patients something they really want -- an upfront price before care is delivered.
Consumers want to know in advance what their outpatient services will cost. A recent survey  by the Advisory Board Company's Market Innovation Center shows that 92% of patients would avoid a clinic where prices were not available in favor of one where prices were known. Giving patients outpatient pricing information is not technically difficult. Most physician offices can look up a patient in their system or the insurance company's system and find the relevant co-payment for a doctor visit or lab test. It's more a question of willingness to provide this information and operational discipline to make it convenient for the consumer.
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October 19, 2015 01:30 PM

'HIPAA Not Helping': Healthcare's Software Security Lagging

The latest Building Security in Maturity Model (BSIMM) study illustrates the long learning curve for secure coding initiatives.
Healthcare's cybersecurity ills are well-known, and a new study of enterprise secure software development shows just how far that sector lags behind other industries.
The new Building Security in Maturity Model (BSIMM) study published today, BSIMM6, found healthcare organizations scored much lower than their counterparts in the financial services, independent software vendor, and consumer electronics industries, when it comes to internal software security programs and practices. BSIMM6 studied more than 100 enterprises including 10 firms in healthcare. Six of those healthcare firms--Aetna, ANDA, McKesson, The Advisory Board Company, Siemens and Zephyr Health--agreed to be named as part of the study, which is headed up by software security firm Cigital Inc. with the help of NetSuite.
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Op-ed: Technology Must Let Doctors Be Doctors

'Going digital' isn't helping health care, writes athenahealth CEO Jonathan Bush.

By Jonathan Bush Oct. 19, 2015 | 8:30 a.m. EDT
When my doctor walks into the exam room, I want her to pay attention to me, not the computer. Not only is that what all patients want, but it's what doctors want, too. Yet doctors today are under pressure to feed the digital beasts.
Health care's latest best-selling M.D. author, Bob Watcher, says that in a 10-hour shift a single doctor might record 4,000 clicks. Worse, much of this activity is routine census taking, driven by insurers and regulators who assume digitization makes it easy to gather statistical data, regardless of whether it contributes to the quality of care.
Doctors are not Luddites. Many were initially enthusiastic at the thought of automating their practices, expecting the same kind of usability and productivity they enjoyed with, say, the software they use to do their taxes. The expectation was that software for medical professionals would at least be that good. The reality is that the more "digital" physicians go, and the longer they use software, the less satisfied they become.
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Meaningful Use Rules Give CIOs Wiggle Room

Scott Mace, for HealthLeaders Media , October 20, 2015

Meeting the new federal meaningful use standards will require much heavy lifting. And health IT leaders should already be preparing for what comes next.

What are healthcare CIOs talking about now that ICD-10 is live?
Meaningful use deadlines took center stage at the annual meeting of the College of Healthcare Information Management Executives (CHIME) in Orlando, FL, last week. But attendees also found time to talk about what comes after meaningful use—namely, CCDA and CEHRT.
Two meaningful use dates now loom large. The first is December 15, when the 60-day comment period on the stage 3 final rule expires. While some industry observers consider the comment period to pertain just to stage 3, that isn't precisely true. Because ONC and CMS issued a single final rule covering both stage 3 and its amendments to stage 2 in the years 2015, 2016, and 2017, the public has the right to comment on anything in the final rule, says Liz Johnson, CIO of acute care hospitals and applied clinical informatics at Tenet Healthcare, the for-profit hospital operator headquartered in Dallas.
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What Veteran CNIOs Want to Tell New Nurse Informaticists

OCT 18, 2015 9:27pm ET
Nurses with a passion for data – that’s one of the key components of success for chief nurse informatics officers.
Those in this role in healthcare organizations understand the specific pressures and duties that nurses face, and how information technology can help improve their ability to deliver care to patients, and use the right IT tools to accomplish that goal.
Several board members of the American Nursing Informatics Association recently shared from their past experiences, aiming to help nursing students and new chief nurse informatics officers with the lessons they learned in their early years as CNIOs.
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Fed Adoption Could Spur More Use of Direct Messaging Software

OCT 19, 2015 7:34am ET
Federal agencies in 2010 started work to create the Direct Project secure messaging protocols as a simple and standard way to exchange encrypted health information. Only now, however, are agencies starting to adopt the technology.
Over time, Direct messaging has evolved to be a supporting messaging option under the electronic health records Meaningful Use program, and is governed by DirectTrust, a coalition of 150 provider and vendor organizations.
Now, the Department of Veterans Affairs and Indian Health Services have received accreditation from the industry-sponsored Electronic Healthcare Network Accreditation Commission for meeting specific requirements for security and identity controls as health information service providers using Direct messaging services.
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Differences in Terminology Challenge Healthcare, Part I

OCT 19, 2015 7:24am ET
Terminology is core to everything in healthcare—from procedures to results to diagnoses. As healthcare organizations increasingly rely on information systems, agreeing on terminology usage and standards is critical to improving care, conducting analytics and other important initiatives.
Unfortunately, no single healthcare vocabulary or terminology can meet all the needs of those who use healthcare information. The variety in terminologies and the variability in how they are used has created an environment of data being trapped in silos. To improve healthcare delivery and research, terminology barriers need to be addressed.
This was the topic addressed in a recent roundtable discussion hosted by Health Data Management and sponsored by Health Language. Here is the first in a weeklong series addressing terminology challenges and possible solutions.
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Cyberattacks could cost providers $305B

Posted on Oct 19, 2015
By Mike Miliard, Editor
Over the next five years, U.S. health systems stand to lose a total of $305 billion from coordinated cyberattacks, according to Accenture. Even worse, their patients are at big financial risk themselves.
The report – The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction – predicts that some 25 million people, one out of every 13 patients, will have sensitive financial data stolen from their healthcare provider's IT systems over the next half-decade.
"What most health systems don't realize is that many patients will suffer personal financial loss as a result of cyberattacks on medical information," said Kaveh Safavi, MD, managing director of Accenture's global healthcare business, in a statement. "If healthcare providers are complacent to safeguarding personal information, they'll risk losing substantial revenues and patients as a result of medical identity theft."
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Survey: BI and Analytics Platforms Will be Key for Healthcare Orgs Moving Forward

October 16, 2015
by Rajiv Leventhal and David Raths
Healthcare organizations are starting to prioritize business intelligence (BI) and analytics initiatives, but challenges remain, according to a survey from HIMSS Analytics and Qlik, a Randor, Pa.-based visual analytics company.
The study, which surveyed 400 respondents, including C-suite, vice president, and director level contacts, confirms implementation of and utilization of BI and analytics platforms result in better decision-making across all segments of a healthcare organization.
With four key areas explored—level of maturity across a variety of use cases, value that has been realized from current initiatives, challenges experienced from current deployments, and future investment plans in healthcare analytics—the survey revealed that BI and analytics platforms provide better internal transparency for easy recognition of clinical and operational efficiencies which can lead to reduction in the average length of stay and higher patient satisfaction.
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Enjoy!
David.

Friday, October 30, 2015

A Couple Of Perspectives On Electronic Health Records That Face Reality For A Change.

This appeared in the New England Journal of Medicine last week:

Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine

Lisa Rosenbaum, M.D.
N Engl J Med 2015; 373:1585-1588
October 22, 2015 DOI: 10.1056/NEJMp1509961
A decade ago, a primary care physician I admired seemed to come undone. His efficiency had derived not from rushing between patients but from knowing them so well that his charting was effortless and fast. But suddenly he became distracted, losing his grip on the details of his patients' lives. He slumped around, shirt half-untucked, perpetually pulling a yellowed handkerchief from his pocket to wipe his perspiring forehead. Everyone worried he was sick. His problem, however, turned out to be the electronic health record (EHR).
Ten years and nearly $30 billion of government stimulus later, the mandate to implement EHRs has spawned many similar stories, some of which Robert Wachter catalogues in The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, which explores the tension between the push to digitize medicine and the sanctity of the doctor–patient relationship.1 Wachter centers his EHR analysis around the story of an 18-year-old given a 39-fold overdose of Bactrim (sulfamethoxazole–trimethoprim) — a near-fatal error partially caused by an EHR. Investigating the root causes, Wachter discovers design flaws, such as defaulting to certain units for medication dosing and alerts rendered meaningless by their sheer number. But he concludes that the mistake stemmed less from the EHR itself than from its effects on our collective psychology. “I realized,” he writes, “that my beloved profession was being turned upside down by technology.”
For inhabitants of this upside-down world, Wachter's “House of Horrors” tour is vindicating. There's the critical care doctor who, unable to identify new information in daily notes, has begun printing them out and holding two superimposed pages up to the light to see what's changed. There's the cardiologist who says, “It could be worse . . . I could be younger.” To these tales of EHR fallout, most of us could add our own. Physicians retiring early. Small practices bankrupted by up-front expenses or locked into ineffective systems by the prohibitive cost of switching. Hours consumed by onerous data entry unrelated to patient care. Workflow disruptions. And above all, massive intrusions on our patient relationships.
These complaints might be dismissed as growing pains, born of resistance to change. But transitional chaos must be distinguished from enduring harm. According to sociologist Ross Koppel, who has studied the EHR's limitations and why they've been largely ignored, one key barrier is that physicians who voice reservations are labeled “technophobic, resistant, and uncooperative.”2 But in fact a recent RAND study showed that most physicians recognize the potential of EHRs and appreciate such features as the ability to view data remotely. Nevertheless, the researchers found remarkable EHR-induced distress. They conclude, “No other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its core users.”3
Lots more here:
Then we has a discussion of Health IT risk.

Your safety can't be guaranteed in the use of IT for healthcare

Monday 19 October 2015 5:30PM (view full episode)
When you think of medical risk you might assume that the most harm would arise from surgery or multiple x-rays.
But what if the use of IT systems was causing you more harm than any visit to the GP?
Farah Magrabi says that this area of healthcare needs to be more thoroughly researched.
She has advised governments on IT-related patient harm in the US, UK and Australia.
Web site is found here:
So many clinicians are unhappy and others have good reason to be concerned about the safety of the tools.
Hardly the nonsense ‘all e-health is good’ that some like DoH, NEHTA and the CHF push.
I think we need much more nuanced discussions.
David.

Thursday, October 29, 2015

The Macro View - General And Health News Relevant To E-Health And Health In General.

October 29 Edition
Well this is the week calm returns with the pollies away for another week and a half.
As always politics and policy inevitably get mixed up in all this so a wide range of views get canvassed.
It is interesting just how quickly the new government is working to get rid of all the ‘stinkers’ (Phil Coorey) in the 2014 and 2015 Budgets.
Interestingly the exclusions of diseases from health insurance is becoming a hot issue, as people discover 'cheap' health insurance may be a big let down.
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Here is some other of the recent other news and analysis.

The Political Scene.

Turnbull stands by policies as Labor lags

Prime Minister Malcolm Turnbull is standing by Abbott government policies on health, education and other budget savings, as Labor seeks to link him to his dumped predecessor.
The opposition used parliament on Monday to quiz Mr Turnbull on whether he still backed a raft of unpopular policies including university deregulation, the Medicare co-payment and $80 billion in slowed-down spending on schools and hospitals.
"All of our existing policies and proposals, whether they are before this house or in the policy statements by ministers, remain on foot," Mr Turnbull said.
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General Budget Issues.

Warning about further cuts to the public service in ACT due to budget 'red ink': report

Date October 18, 2015 - 11:45PM

Ross Peake

Senior reporter for The Canberra Times

The federal public service could be hit with another round of swingeing cuts to rescue the Budget from a "sea of red ink", according to an economic forecast to be released on Monday.
It warns that new Treasurer Scott Morrison is already increasing the rhetoric about spending being the problem, not revenue.
However, the Deloitte Access Economics Business Outlook says job growth in the ACT has continued to pick up, growth in retail sales is slightly ahead of the national average and small business confidence is also slightly ahead of the national average.
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  • Updated Oct 20 2015 at 9:00 AM

Budget repair a difficult and long-term challenge, says Turnbull

Prime Minister Malcolm Turnbull left open the door to further delays returning the budget to surplus – one of the biggest challenges facing his government – after the independent Budget Office warned slow economic growth would mean less money for government services.
With the Coalition swinging its focus towards preparations for the mid-year budget update, which is due within eight weeks, Mr Turnbull cautioned that delivering a budget surplus would be a "very difficult … and long-term challenge".
The remarks are a sign the government is eager to manage expectations about how quickly it can repair the budget, which is under pressure from falling commodity prices, lower sharemarket dividends and faltering wages growth.
By promising to pursue policies that boost economic growth, spur innovation and encourage infrastructure investment, Mr Turnbull has probably made it harder to balance the budget. The full-year 2015-16 budget deficit is forecast to be $35.1 billion. Gross government debt hit a record $402 billion on Friday.
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Budget projections to be revised: Morrison

  • AAP
  • 20 Oct, 5:14 PM
Treasurer Scott Morrison says the projection of a return to budget balance within four years will be revised by the end of the year.
The current budget papers project a balanced budget in 2019/20 after a series of deficits.
Asked whether he stood by the projection, Mr Morrison told Sky News on Tuesday the latest figures would not be known until the mid-year economic and fiscal outlook due in December.
"Those projections and those forecasts will be revised in MYEFO and refreshed," Mr Morrison said.
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  • Oct 20 2015 at 5:09 PM
  • Updated Oct 20 2015 at 8:33 PM

Scott Morrison waters down cuts to family payments

The government has watered down some of the harshest cuts proposed in its notorious 2014 budget a bid to secure a passage through the Senate.
Just after announcing the government's response to the financial system inquiry, Treasurer Scott Morrison and Social Services Minister Chris Porter secured the support of the Coalition party room to offer the compromises.
These include lifting from six years to 13 years the age of a family's youngest child at which the government would cut off family tax benefit part B payments.
Family tax benefit part B is paid to single-income families and is means tested at $100,000 a year. In the 2014 budget the government sought to lower the cut-off age from 16 to six but has been unable to get it through the Senate. The measure was budgeted to save $5.1 billion over the next four years.
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Families win as Coalition eases cuts to benefits

  • The Australian
  • October 21, 2015 12:11PM

David Crowe

Rosie Lewis

Treasurer Scott Morrison has labelled the government’s compromise package on cuts to family tax benefits a “better offer”, as the Turnbull government retreats on the controversial policy from last year’s unpopular budget.
Mr Morrison said today’s package was the product of months of negotiations with Labor and the crossbench, but the opposition and some independent senators have already expressed some concerns about the new proposal.
“It’s a better package, it’s a better offer and it also achieves the government’s savings objectives so we haven’t had to walk away from that and nor would we because as a government we know you’ve got to pay for what you spend,” Mr Morrison said.
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  • Oct 22 2015 at 4:17 PM
  • Updated Oct 22 2015 at 5:49 PM

RBA makes $6.1b from falling $A

Treasurer Scott Morrison will be the main beneficiary of a $1.6 billion windfall from the Reserve Bank of Australia after it generated more than $6 billion in profit from the falling Australian dollar.
The payment from the central bank to Treasury's coffers - which was made on September 3, a day after the Reserve Bank's accounts were finalised - is the biggest to government in 13 years, except for Wayne Swan's 2009 draw-down of $5.2 billion.
Determined by both Reserve Bank governor Glenn Stevens and former Treasurer Joe Hockey, the payment is almost equivalent to what the bank delivered Canberra over the previous five years.
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Family tax benefit cuts: more than 130,000 single parents would lose out

Date October 22, 2015 - 6:01PM

Judith Ireland

National political reporter

Family tax benefits revamped

The government remodels its family welfare changes to pass the senate while still delivering savings.
More than 130,000 single parents stand to lose family benefits under the Turnbull government's family payments plan. 
Department of Social Services officials have told a Senate committee in Canberra that 136,000 single parents will see a reduction in family tax benefit part B once their youngest child turns 13, if the government gets the green light from the Senate for its new package
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Grandparents and single parents to be spared in welfare cuts — others to lose up to $5700-a-year

October 25, 2015 12:00am
Samantha Maiden National political editor The Sunday Telegraph
TREASURER Scott Morrison has offered to exempt grandparent carers and some single parents from tough family ­payment cuts that will slash up to $5700-a-year from families with teenagers.
In an exclusive interview, the Treasurer said it was vital to secure Labor’s support for the budget savings in the ­welfare portfolio to pay for childcare reform.
Parents face a double hit under Malcolm Turnbull’s “fairer’’ family payments plan because of the combined impact of the family tax benefit changes and the looming abolition of the Schoolkids Bonus.
The hit to family budgets is designed to encourage parents to get back into the workforce but will strip payments from around 1.7 million low and middle income families.
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Health Budget Issues.

9:58am October 21, 2015

Medicare safety nets being merged

AAP
The government is tidying up the Medicare safety net.
Health Minister Sussan Ley on Wednesday introduced a bill to parliament to remove the two existing safety nets and the Greatest Permissible Gap and replace them with a single safety net.
Ms Ley said the change would ensure a strong safety net continues to protect all Australians from high costs for medical services provided out of hospital.
The current safety nets were complicated and confusing, had different thresholds and were inconsistent.
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Digging deeper hole on hospital

October 21, 20159:48pm
CHRISTOPHER WALSHThe Australian
FEDERAL Health Minister Sussan Ley has warned the CLP Government that any delays at the Palmerston Hospital will be at the Territory’s expense and that the situation will be monitored.
The warning comes after revelations that the so-called first pour of concrete for a central stairwell at the hospital site has been buried in dirt and abandoned.
And yesterday NT Health Minister John Elferink continued to dig his own hole, blowing up in a press conference twice while trying to explain why last Friday’s concrete pour was not a $20,000 taxpayer-funded publicity stunt.
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Labor asks for audit of funds for hospital where hole was dug and filled in

Northern Territory government denies media event to mark the first concrete pour was staged but Labor senator and MPs ask auditor general to investigate
Helen Davidson in Darwin
The federal Labor party has written to the auditor general requesting the funding of a Northern Territory hospital at the centre of an alleged government media stunt be examined.
The Palmerston hospital project, which has $110m in federal funding, came under scrutiny this week when the NT government was accused of staging a media stunt at the construction site. The health minister, John Elferink, invited media to attend the first concrete pour last Friday, only for the hole to be filled in and covered up in the days following.
The NT government denied the event was staged and said construction site managers Lend Lease filled it in for “public safety” but did not answer questions on why it was dug in the first place or who made the decision.
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Business plots Medicare takeover

Date October 21, 2015 - 11:30PM

Noel Towell

Reporter for The Canberra Times

Big companies want to take over the processing of Medicare claims and assess eligibility for benefits as well as run the agency's call centres and other functions, internal Health Department documents reveal.
The federal government is considering bringing in a private player to take over Medicare's payment system but documents released under FOI laws show that big business is hungry for a much bigger chunk of the Medicare pie.
The department has been approached by private-sector players who want to take over claims processing, benefit assessment, call centres and registrations.
The documents were release after an FOI request by the Community and Public Sector Union, which is bitterly opposed to any outsourcing, fearing its members at Medicare's parent department Human Services might lose their jobs.
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Medicare: 'Thousands more' to receive benefits under merged scheme

Date October 21, 2015 - 7:35PM

Jane Lee

The Turnbull government will pay thousands more Medicare benefits to help patients with out-of-hospital costs under a plan expected to save it millions of dollars, a Senate estimates hearing has been told.
Health Minister Sussan Ley introduced the plan to merge two Medicare Safety Nets into Parliament on Tuesday. The changes will lower the spending thresholds required for patients to access benefits, but cap the benefits payable for individual medical services once this has been reached.
Ms Ley said the plan offered patients up to one-and-a-half times the fee for a medical procedure once they reached their safety net. It was expected to save $266.7 million over five years, which would go into the Medical Research Future Fund.
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Medical Future Fund.

Scientists in sales pitch for Medical Research Future Fund

  • The Australian
  • October 19, 2015 12:00AM

Rosie Lewis

Australians will be asked to embrace the $20 billion Medical Research Future Fund as leading scientists launch a national campaign to expose the “critical role” it will play in the future health of the country.
With notable names such as Gustav Nossal, Ita Buttrose, Natasha Stott Despoja, Patrick McGorry and Carrie Bickmore volunteering to front the campaign, it will run on TV and online and highlight the need to invest in treatments and cures for conditions such as dementia, brain cancer, mental illness and heart disease.
The fund was one of the Abbott government’s signature budget measures last year and passed the Senate in August despite the dumping of the controversial GP co-payment that had been designed to bankroll it.
Ms Buttrose, Alzheimer’s Australia national ambassador, said it was “imperative” the nation invested in medical research to find treatments and a way to slow down the progression of dementia.
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Health Insurance Issues.

Health funds demand action on overservicing

  • The Australian
  • October 20, 2015 12:00AM

Sean Parnell

The government must target overservicing by doctors in both the public and private sectors to bring spiralling costs under control, leading health funds say.
With cost pressures prompting insurers to consider premium ­increases again, Health Minister Sussan Ley has agreed to address affordability issues in the sector.
A separate Medicare review will have flow-on effects, potentially reducing government ­rebates and benefit outlays, but funds Bupa and HCF want more action on overservicing.
The managing director of Bupa’s health insurance business in Australia, Dwayne Crombie, said there were “perverse incentives” that led doctors to see, test, scan and treat more patients and conditions than necessary. “There is quite a bit of inappropriate care and overservicing going on and it’s pretty hard to question doctors on whether it is needed,” he said.
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Watchdog blasts health insurers

Andrew Tillett Canberra
October 21, 2015, 12:30 am
Health fund members are confused and potentially misled by insurers about their cover and slugged with shock out-of-pocket costs, the competition watchdogs warns.
In a scathing report on the industry, the Australian Competition and Consumer Commission says a “number of market failures” left customers struggling to compare policies because they were so complex.
The Turnbull Government seized on the report to promise a fix for the health insurance industry’s ailments.
The insurer’s peak lobby group laid the blame for complexity on government regulation of the sector and argued that the raft of policies on offer was good for consumer choice.
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Health fund covers 88-year-old man for baby but not hip replacement

October 24, 20154:55pm
Stuck ... Health fund exclusions leave patients without cover.
Sue Dunlevy News Corp Australia Network
ELDERLY men are being sold health insurance that covers them for having a baby but not a hip replacement as private hospitals warn health fund exclusions have reached crisis point.
Taxpayers spend $6 billion a year subsidising private health insurance but the number of people who find their fund doesn’t cover their surgery has tripled in the last few years.
Just days after the consumer watchdog, the ACCC, set up an inquiry to put health funds through the wringer, a News Corp investigation has found many people are finding their health funds desert them when they need help.

ACCC report on private health insurance – an analysis

Editor: Jennifer Doggett Author: Ian McAuley. John Menadue and Jennifer Doggett on: October 24, 2015
Last Tuesday the Australian Competition and Consumer Commission (ACCC) released its  report on private health insurance.  Private health insurance (PHI) was also in the news a day later with the standing down of the CEO of Medibank Private, the largest PHI company.
In the following piece, Ian McAuley, John Menadue and Jennifer Doggett analyse the report and discuss its implications for the future of private health insurance policy. In particular they challenge the Report’s underlying assumption that competition is desirable (or even possible) in many areas of health care. They write:
The ACCC report has been a regular report since 1999, when the Howard Government introduced a swag of subsidies for private health insurance. It covers specific “consumer” issues, such as possible false or misleading representation of products, anti-competitive behaviour, and the incidence of unexpected out-of-pocket expenses.
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It has been an interesting time with the new Government settling in and all sorts of options now back on the table, including the Harper Competition Review - pharmacy might be worried. Health is also clearly under review as far as its budget is concerned. Lots to keep up with here! Enjoy.
David.

Wednesday, October 28, 2015

Just What Are The Implications For The Health Identifier Service Of This Announcement? I Wonder How The Public Will React?

This appeared last week:

Turnbull promises national digital identity, fintech committee

Government tables long-awaited response to FSI report.

The federal government has adopted the majority of recommendations made in last year's financial systems inquiry report, promising to deliver a national federated digital identity framework and a public-private sector innovation committee for the financial sector.
In its long-awaited response to the December 2014 report, tabled today [pdf], the federal government also said it would ask the Productivity Commission to review options to improve data-sharing within the sector, and remove regulatory impediments to modern product information disclosure.
By the end of next year, the government also intends to consider how to amend priority areas of regulation to make it technology neutral.
Digital identity
The FSI report, led by David Murray, highlighted a national federated digital identity as key to improving the efficiency of digital identity processes as well as to minimise the costs and regulatory burden of customer authentication for financial services firms.
Its recommendation - accepted by the government - called for the establishment of a framework under which private and public sector bodies could compete to supply digital identities.
A single minister should be given responsibility for the framework, the report suggested, and a private-public sector taskforce should develop the detail of the framework and standards.
Banks and other financial services firms are currently required to verify an individual using government-issued, paper-based credentials such as a passport or drivers license.
By introducing a national digital identity framework, reliance on paper-based mechanisms could be reduced, making the process more secure and convenient for customers and more efficient for governments and banks, the FSI report said.
It recommended the government utilise the national document verification service, the myGov service portal, the national e-authentication framework, the Finance department’s third-party identity services assurance framework, and the government’s Vanguard electronic authentication service, among others, to create the framework.
The government today said it would task its Digital Transformation Office with developing the trusted digital identity framework.
There is also some coverage here:

Orwell returns: Government promises to implement digital ID for all

COMMENT: After being returned to office in 1987, Prime Minister Bob Hawke triumphantly announced that he now had a mandate to introduce an ID card for all Australian residents. Such was the outcry, that Hawke backed down and talk of the card disappeared into the ether. In 2015, the Orwellian Australia Card has returned in the form of a digital ID.
Buried deep in the bowels of the 32 page Government Response to Financial System Inquiry report by former Commonwealth Bank CEO David Murray, were some chilling sentences that confirmed the Government’s intentions to figuratively stamp the biblical mark of the beast’ on every Australian residents’ foreheads.
In actual fact, the ‘mark of the beast’ happens to be a national system to implement a digital identity for all individuals, which was recommended by Murray in his report.
Here are the actual words on page 20 of the document:
Digital identity.
Develop a national strategy for a federated-style model of trusted digital identities.
The Government agrees that a national digital identity strategy will help to  streamline individuals' engagement with government and provide efficiency improvements.
The Digital Transformation Office will work across government and with the private sector to develop a Trusted Digital Identity Framework to support the Government's Digital Transformation Agenda.
As is always the case with government propaganda, the words are couched in benevolent terms - ‘streamline individuals’ engagement with government’.
In actual fact, what this really means is a more convenient way for government to track and keep tabs on every single living soul residing in this country - from birth until death.
As they have in the past, proponents of the scheme may argue that if you have nothing to hide then why should you be concerned. After all, you don’t mind using your Medicare Card or Driver’s License to identify yourself.
The answer is of course that Australians are not by law required to carry either card as proof of identity or to perform transactions. In fact, we are a freedom loving people who love the freedoms that Australia has always provided and who don’t like to be presided over by authoritarian governments - especially centralised federal governments.
More here:
What is going to be very interesting is to see what the reaction to this is. Will people be thrilled or see the plan as the Australia card Mark III.
Also, if we have a digital id that we can use to move money etc. will the same id be used for health care identification for the individual?
Will be interesting to watch over the next year or so.
David.