Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, April 22, 2018

The Way Health Information Is Handled In Australia Looks Like Changing. Badly Needed Indeed.

A kind commenter sent this link to the blog today:
Following it you get this:

Interoperability and Connected Healthcare in Australia Early Engagement Paper

27 February 2018 V1.0  - Approved or external use
Document ID: Interoperability Early Engagement Paper Version 1.0
What is not clear is just why it is hosted on the Aust. College of Emergency Medicine Website? This also looks to be the only copy out there.
The whole document is well worth a read (Written by EY) but there are some highlights to me:
First:
What Can We Learn From Other Industries And Countries?

There is much to learn from the experience of other industries and other countries’ health systems.
Examples of successful interoperability in other industries include the financial services sector, the aviation sector, and the smartphone ecosystem. An examination of these industries by Ernst and Young shows common themes:
·         The need for clear regulatory and legislative frameworks. For example, in the financial services sector, clear rules and protocols are set and governed by the Reserve Bank of Australia’s Payments System Board and by the Australian Prudential Regulatory Authority.
·         Reliance on standards bodies. The telecommunications industry has a single global mobile standard: the Global System for Mobile Communications (GSM). In the smartphone environment, the rules for developers to participate in the ecosystem are set by the operating system controllers.
·         Clear leadership. For example, in the aviation industry, all airlines rely on the International Civil Aviation Organization (ICAO), and the European  Organisation for Civil Aviation Electronics.
·         Collaboration and self‐regulation. For example, the Australian Payments Network (AusPayNet) is a membership‐based industry association that acts as a self‐regulatory body.
This points to the need to resolve the issue of ‘who sets and enforces the rules’ for Australian healthcare interoperability, and the balance between government and self‐regulation.
Other countries have taken various approaches to health interoperability. A summary of these countries that are most relevant to Australia’s healthcare system may be found at
There are recurring themes across different health systems that point to issues that need to be resolved in the Australian healthcare context to promote interoperability, and in doing this, connected healthcare:
·         Most countries have a government body with some responsibility for standards and interoperability, although this varies from ‘mandating’ to ‘facilitating’. Some countries complement this with a degree of self‐regulation.
·         There are varying approaches to how data is exchanged, some with centralised data repositories and others with distributed models where patient data is stored in the original collection point and extracted when required.
·         Most countries have a system of unique patient identifiers, with some extending this to both health and social system (with clear benefits of an integrated social approach to healthcare).
·         Most countries draw on international terminology standards, rather than creating their own.
·         Various ‘levers’ have been used to promote adoption, ranging from mandating standards, to stipulations in funding agreements, to providing resource materials (toolkits, implementation guides).
Second:

What makes interoperability?


Enabler
Relevance to interoperability

Identity management
Uniquely identifying health consumers, health and care providers and health organisations in the healthcare ecosystem.
‘I am who I say I am’.
Authentication and authorisation
Ensuring appropriate levels of access to a patient’s health information.
‘As a clinician, I can get access to the information I need to provide care’.
‘As a consumer, I have access to my information and have control over who can access it’.
Integrated electronic health record
Allows health consumers, health and care providers and other participants to access health information, with the consumer at the centre.
‘My health information is available to clinicians involved in my care’.
Unified health directory services
Provide the technology for health consumers and health and care provider to find health services quickly.
‘I can easily find the health and care providers I need to communicate with electronically’
Information exchange
Developing clinical informatics specifications to facilitate information exchange in alignment with relevant data quality and clinical safety requirements.
‘My clinical software communicates with other systems to bring me what I need’.
National standards
Promoting the definition and adoption of consistent standards to facilitate information exchange and provide conformance and compliance mechanisms.
‘Minimum standards are accessible and easy to understand and implement’.
Security
Common standards, understanding and adhering to required policies to protect the privacy and integrity of information.
‘I can rest assured that my information is secure’.

Third:

What shifts to current Australian paradigms do we need to consider?

Comparing international and other industry approaches to interoperability exposes a number of opportunities for Australia. While individual technologies or implementation approaches will need be co‐ designed at a later time, this analysis suggests a number of possible paradigm shifts that may be appropriate in the Australian context. These are described below.

Moving away from an exclusive reliance on a document paradigm

Currently, My Health Record receives information in one of a range of document types that are available for different purposes[13]. There are some advantages to this model: It reflects the traditional practice of healthcare to communicate in documents and does not require a high degree of common terminology. Specialists in Australia, for instance, are familiar with reading referral letters from General Practitioners who have trained and practiced globally, and have differences in terminology.
While documents will continue to play an important role in healthcare communication, some data may be better captured in an atomic form. Atomic data captures information in discrete packets that represent something about a person or service. Frequently, this is numerical data, representing a blood test result, a height, weight, heart rate or blood pressure

Strengthening the use of identifiers for patients, providers and services.

Most Australians have an Individual Healthcare Identifier[14]. However, not all regular care users in Australia have an Individual Healthcare Identifier (IHI). There are also variations in how IHI’s are looked‐up, stored and used in different care provision settings.
It is just as important that we are able to identify providers of care in order to make information on patients available to them. Current provider identification systems, including NASH certificates, are cumbersome and there are ways in which these can be streamlined without compromising security.

Develop new collaborative models for the governance and approval of standards and specifications

The implementation of co‐ordinated improvements will require a multitude of decisions as to “how”. Without agreement on how information will be made available, requested and transmitted, widespread implementation is impossible.
The standards and specifications that define all of this must be developed collaboratively with industry and with a strong focus on suitability for use in the clinical setting.
The process itself for achieving this must be developed in partnership with stakeholders.

Extending the role of My Health Record to include acting as a trust broker to facilitate access to information or resources that are held on other systems.

Currently, My Health Records acts primarily as a repository for information. Clinical information is uploaded into My Health Record by some people and downloaded by others. This limits the type and amount of information that My Health Record is able to facilitate access to. In the age of wearable devices and widespread home monitoring, there may be value in enabling consumers to use My Health Record to link information from disparate sources. Similarly, My Health Record could provide capacity to link a radiology report to the associated images (stored elsewhere) enabler clinicians to have faster access to diagnostic images.
Fourth:

Data rights and responsibilities in Australia

Globally, the issues associated with access and custodianship of information are being redefined in ways that reflect the changing nature of a consumer’s relationship with information about themselves or those that they care for.
The European Union has introduced the General Data Protection Regulation[15], which comes into force on 25 May 2018. These regulations includes provisions for:
Right to Access
Part of the expanded rights of data subjects outlined by the GDPR is the right for data subjects to obtain from the data controller confirmation as to whether or not personal data concerning them is being processed, where and for what purpose. Further, the controller shall provide a copy of the personal data, free of charge, in an electronic format. This change is a dramatic shift to data transparency and empowerment of data subjects.
and Data Portability
GDPR introduces data portability the right for a data subject to receive the personal data concerning them, which they have previously provided in a 'commonly use and machine readable format' and have the right to transmit that data to another controller.
A similar approach is envisaged in the United States with the US Office of the National Coordinator for Health Information Technology defining interoperability as[16]:
the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.
This reference to ‘without special effort’ draws upon the growing body of agreed, open‐source, Application Programming Interfaces that allow consumer facing applications (like Apple’s new Health Application) to draw information from a range of clinical systems using a standardised approach with the consumer’s consent. Essentially, Government and Industry have collaborated to define a set of interfaces, increasing over time, by which systems share information that becomes the de facto standard of what is reasonable as opposed to being ‘special effort’.
In Australia, the Privacy Act 1988 governs how personal health information is managed by government and the private health sector, with additional legislative requirements applying in states and territories for state based health providers. The Privacy Act and the Australian Privacy Principles it contains, give the consumer the right to access to their own health information, with entities who hold that information obliged to provide it in the manner requested by the individual unless one of a number of lawful exceptions applies. The principles provide that an entity may charge the consumer the reasonable costs of providing this information in the manner requested.
The Australian Government Productivity Commission examined the issues associated with data availability and use, reporting in 2017[17]. This report made a number of observations regarding the potential to improve outcomes and the effectiveness of the health system more generally. Importantly, the report makes the following recommendation:
Marginal changes to existing structures and legislation will not suffice. Recommended reforms are aimed at moving from a system based on risk aversion and avoidance, to one based on transparency and confidence in data processes, treating data as an asset and not a threat. Significant change is needed for Australia’s open government agenda and the rights of consumers to data to catch up with achievements in competing economies.


·         At the centre of recommended reforms is a new Data Sharing and Release Act, and a National Data Custodian to guide and monitor new access and use arrangements, including proactively managing risks and broader ethical considerations around data use.
·         A new Comprehensive Right for consumers would give individuals and small/medium businesses opportunities for active use of their own data and represent fundamental reform to Australia’s competition policy in a digital world. This right would create for consumers:
o   powers comparable to those in the Privacy Act to view, request edits or corrections, and be advised of the trade to third parties of consumer information held on them
o   a new right to have a machine‐readable copy of their consumer data provided either to them or directly to a nominated third party, such as a new service provider
These proposed reforms, and the emergence of consumer‐facing applications nationally and internationally, demonstrate a growing expectation in the community that a consumer’s data both can and will be made usefully available.
----- End Extracts:
There is lots of news here:
1. The myHR is obsolete and hardly relevant. Large document storehouses are a health hazard!
2. Standards matter! And you actually need to understand what they mean and require.
3. There are big changes coming to data control and ownership including health and a GPDR like mechanism(s) is coming over time.
4. The myHR is going to be radically changed as to how and what it can hold and what control patients have. And it has to be able to properly delete old, unwanted material.
5. Primary systems are what clinicians are using – what a surprise!
Have a hunt for other nuggets. It looks to me – on this basis of this – that the ADHA is being dragged in at least way towards some more sensible directions!
Comments please and sorry the formatting is a bit poor!
David.

Added about 5pm. The document totally misses out on pointing out just how complex and difficult real interoperability is I believe. The learning curve has not really begun I reckon!

D.
 

AusHealthIT Poll Number 419 – Results – 22nd April, 2018.

Here are the results of the poll.

What Do You Think Are The Prospects For Useful And Worthwhile Outcomes To Come From The Newly Announced Digital Health Co-operative Research Centre (CRC)?

Excellent 2% (3)

OK 6% (7)

Neutral 40% (49)

Unlikely 44% (53)

No Chance At All 7% (9)

I Have No Idea 0% (0)

Total votes: 121

Looks like 90% are neutral or worse on the prospects of the CRC with 51% saying useful outcomes were unlikely!

Any insights welcome as a comment, as usual.

A really, really great turnout of votes!

It must have been a really easy question as no reader was not sure what the appropriate answer was.

Again, many, many thanks to all those that voted!

David.

Saturday, April 21, 2018

Weekly Overseas Health IT Links – 21st April, 2018

Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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ECRI Institute launches tool to help EHR vendors track patient safety

The new Insight Culture of Safety Assessment for Health IT Companies was built to help vendors adhere to principles of safe design, development and use when creating products.
April 12, 2018 12:02 PM

ECRI Institute, through the multi-stakeholder Partnership for Health IT Patient Safety it convened in 2014, has announced a new tool to help electronic health record and other IT vendors assess how well they're keeping safety in mind when designing their products.
The new Insight Culture of Safety Assessment for Health IT Companies is built around a three-part safety vision, officials say: safe design and development, safe use, and safe implementation of IT for safer care.
"Ensuring a strong culture of safety can help avoid costly disruption of business and unwanted legal and regulatory actions," said Lorraine Possanza, program director for the partnership for Health IT Patient Safety, in a statement.
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HIT Think How to turn a doomed data project into a digital delight

Published April 13 2018, 6:12pm EDT
Savvy entrepreneurs know that a successful business starts with identifying a real problem in the market. Only then do you build a team, develop a prototype and create a company, moving gradually against clear objectives to minimize risk.
We should think about data initiatives in the same way. If you embark on a “data project” at your organization, you’re setting yourself up to fail. That’s because “data projects” almost by definition are ill-defined and unfocused. In fact, Gartner has estimated that 60 percent of big data projects are abandoned before they get past the pilot stage, citing a lack of clear objectives, over-investment in complex tools, and a failure to get buy-in from stakeholders.
I’d argue the real reason, however, is that we’ve come to believe data has inherent value. Ever since The Economist declared that data is “the world’s most valuable resource,” businesses have been scouring their organizations for every scrap of information that might be useful and throwing it in a massive data lake without thinking through how that data will actually drive the business forward.
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10 leading causes of death in the U.S.

Published April 13 2018, 5:33pm EDT
The 10 leading causes of death, according to the most recent figures from the Centers for Disease Control and Prevention, included cancer, respiratory disease and stroke. However, new health data initiatives promise to provide early interventions and better care, which could significantly reduce the impact of these killers. What follows is a list of the top 10 causes of death in America, according to the most recent annual CDC numbers, and a look at some of the technologies being deployed to help save Americans’ lives.
1. Condition: Heart disease
Deaths: 633,842 Americans
Health data initiative: A new technique developed at Cedars-Sinai Medical Center for conducting cardiac magnetic resonance imaging tests is offering a potential solution for solving a major problem associated with using conventional methods to perform MRI scans—how to get a still image when a beating heart and blood flow can blur the picture.
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Healthcare's $3 trillion question: Should the likes of Google and Facebook control this data?

How is data managed? Do users get to have consent over how their data is used? And do they get a cut out of the value generated by using that data? Let's take a walk on the wild side.
By for Big on Data |
April 7 is World Health Day, and the occasion warrants a closer look at the way healthcare-related data is managed. The challenges are laid out in the World Health Organization's bulletin on policy implications of big data in the health sector:
In the field of health-related big data, the public needs to be reassured that security measures are mandated and enforced. As new analytical models, data sources and stakeholders increasingly build into dynamic relationships, it may be helpful to think of health-related big data as an evolving ecosystem.
There are several challenges to the future development of this data ecosystem. Even basic health data can be misused and lead to discrimination, especially of vulnerable populations. The fair distribution of any new benefits that may arise from the collection and analysis of big data may also pose hard challenges.
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12 top HIT trends

Published April 12 2018, 11:59am EDT
Editors from Health Data Management spent several days at HIMSS18 in Las Vegas last month. After attending many educational sessions, meetings with vendors and other professional groups, and discussions with dozens of attendees, the following major trends emerged from the industry’s largest show, suggesting that they will impact the use of IT in healthcare. These common themes emerged as important trends at the conference.
1. AI/machine learning
Artificial intelligence and machine learning were the buzz again, with some providers beginning to demonstrate practical applications for specific uses of technology, particularly in radiology where AI is being in specific use cases, such as identifying cancer in breast tissue. However, most results are early, and the next phase appears to be the ability to deploy solutions so that they’re available at the point of care without creating additional workflow burden on clinicians.
2. APIs
There was more talk about using application programming interfaces to facilitate data exchange. For example, APIs will play a role as the federal government seeks to expand options for data sharing. The Centers for Medicare and Medicaid Services announced a next-generation version of the Blue Button program that enables Medicare beneficiaries to get and share claims data with family and friends and other entities. CMS is working with Human API, a vendor that markets a FHIR-based application that supports secure data sharing.
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Hackers claim they can breach a hospital in less than 5 hours: 10 report insights

Written by Julie Spitzer | April 11, 2018 | Print  |
Most hackers claim they are able to break into their victims' computer systems, determine their most valuable data and extract it within 15 hours, according to recent survey exploring the minds of hackers.
In its 2018 Black Report, cybersecurity, risk and compliance software company Nuix sought to explore the disconnect between organizations' presumed cyber defenses and real-world threats by talking to  hackers. 
Here are 10 things to know about hackers.
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U.S. FDA approves AI device to detect diabetic eye disease

 (Reuters) - U.S. health regulators said on Wednesday it will allow sale of the first medical device that uses artificial intelligence (AI) software to detect greater than a mild level of the most common cause of vision loss among more than 30 million Americans living with diabetes.
The device, called IDx-DR and produced by Iowa-based IDx LLC, is the first to receive Food and Drug Administration authorization that provides a screening decision without need for a clinician to also interpret the image or results. That makes it usable by health care providers not normally involved in eye care, such as primary care physicians who interact far more frequently with patients with diabetes.
It was reviewed under new FDA regulations designed to speed to market some devices seen as low- to moderate-risk and for which there is no prior legally marketed device, part of Commissioner Scott Gottlieb’s efforts to streamline approvals on a variety of fronts, including generic drugs and cheaper versions of costly biotech medicines.
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CVS pharmacists will have new tools to help patients save money on drugs

April 11
CVS Health is rolling out a tool to alert its 30,000 pharmacists to cheaper drug options when they fill patients' prescriptions.
For years, pharmacists have substituted generic drugs for identical brand-name versions. But CVS Pharmacy's Rx Savings Finder program will enable pharmacists and consumers to question doctors' prescription choices to save patients money.
If the software flags a less expensive therapeutic equivalent, the pharmacist will tell the patient and seek permission to ask their doctor to make the switch. It is also being made available directly to CVS Caremark consumers through an app.
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Survey: 50 percent of EHR-using docs unsatisfied with patient data access

April 11, 2018
A recent survey of 300 primary care physicians who use EHRs found that half of the respondents wanted better access to patient data.
The survey, which was commissioned by electronic prescribing and health information company SureScripts and administered online by ORC International during October of last year, also investigated physicians’ opinions on the availability of medication adherence and drug pricing information.
“Addressing physicians’ information needs and challenges is critical in an increasingly value-driven industry,” Dana Benini, vice president of Healthcare Practice at ORC International, said in a statement. “The Surescripts survey is an important inside look at physicians’ real-world information access and interoperability challenges and the opportunities to solve them.”
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HIT Think How technology can assist discharge planning and aid efficiency

Published April 12 2018, 5:32pm EDT
In today’s value-based environment, hospitals are under financial pressure to discharge patients sooner while ensuring patient safety and quality of care. This challenge comes with the clear risk that releasing patients too quickly can result in costly readmissions.
Discharge planning that requires care coordination is a complex process. Managing the transition from the hospital to a post-acute setting can be time consuming for discharge planners and care management staff. If prior arrangements with a particular facility are pending or have not been initiated, patient placement requires extensive communication and coordination among multiple care team members.
Considering the volume of patients released daily from a hospital, case managers often devote half their time to discharge planning. Statistics posted by the American Hospital Directory (AHD) show 31,787,121 annual discharges in the U.S. for 2017, an average of 87,088 discharges each day from U.S. hospitals. It’s no wonder the best efforts of case managers may not ensure the best post-acute option. Even with expanding EHR integration, many hospitals still rely on manual processes to manage patient care transitions.
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The emergence of personalised e-health care

CEO of Liva Healthcare, Kristoffer From explains the emergence of personalised e-health care and asks if e-health can close the gap between doctors and diabetic patients

Type 2 diabetes is a vast and growing, health problem for the UK. 3.7 million people in the UK are currently living with diabetes, 90% of which have Type 21. If the current trend persists, over five million people will have diabetes by 20251. The health consequences of Type 2 diabetes cannot be ignored. The condition is a major contributor to vision loss, kidney failure, heart attack, stroke and lower limb amputation.

Managing Type 2 diabetes

Traditional interventions for diabetes prevention have focused on counselling and medicine. However, these solutions alone are no longer enough to tackle the long-term health crisis the UK is facing. To reduce the number of people being diagnosed with Type 2 diabetes – we need to address the common root cause – unhealthy lifestyles.
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Patient Safety – Advisory Series, March 2018

By Claire Read – Digital Health
Many believe that technology has a crucial role to play in reducing avoidable harm and bolstering safety in the NHS. And while digital solutions are being designed to improve care, they will be properly effective only if they are efficient and reliably implemented. Claire Read reports.
About 15 years back, Suzette Woodward and her colleagues sat down to confront quite the complex challenge: how could the NHS build a system through which avoidable patient harm could be reported, analysed and, crucially, learnt from?
Woodward was patient safety director at the National Patient Safety Agency – the body then responsible for reducing avoidable harm across the NHS – and developing that system was one of its primary goals. And so, in 2003, the National Reporting and Learning System (NRLS) was born.
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AMA partners with Google on interoperability challenge

Apr 10, 2018 10:15am
The American Medical Association (AMA) has partnered with Google to launch a contest that challenges the startup community to come up with a solution that allows patients and clinicians to share patient-generated data.
The “Health Care Interoperability and Innovation Challenge,” sponsored by Google, calls on participants to transfer data captured by wearables or mobile apps “into one or more phases of clinical care” that can be “transformed into accessible and actionable information for the patient and physician to improve health outcomes,” according to an announcement.
Specifically, the AMA wants to see solutions that can help assess current conditions, develop treatment plans, record outcomes or prompt clinicians to intervene when necessary. Entrants are also asked to transfer data from the clinical care environment back to a mobile device or application.
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HHS issues new guidance on SamSam ransomware

Written by Jessica Kim Cohen | April 10, 2018 | Print  | Email
HHS' Healthcare Cybersecurity and Communications Integration Center released a report March 30 on SamSam, an ongoing ransomware campaign that has targeted the healthcare and government sectors since 2016.
There have already been at least eight SamSam attacks on healthcare and government organizations since the beginning of 2018, including attacks on two Indiana-based hospitals and EHR provider Allscripts, which faces a class-action lawsuit as a result of the attack, according to the report obtained by the American Hospital Association.
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Suggestions Offered to Reduce Physician Frustration With EHRs

Eight suggestions include providing individualized optimization training to personalize EHR settings
TUESDAY, April 10, 2018 (HealthDay News) -- Changes can be implemented to help reduce physician frustration with electronic health records (EHRs), according to an article published in Medical Economics.
In order to help physicians become more efficient and reduce their frustration with the EHR system, Martin Pricco, M.D., M.B.A., from the Gould Medical Group in Modesto, Calif., offers eight suggestions for changes that can be implemented.
The suggestions include improving the password process so that physicians do not need to spend time typing passwords into workstations. Practices should provide or allow physicians to attend individualized optimization training in order to personalize EHR settings; physicians need a minimum of six hours of training, some spent in the classroom and some spent with a trainer. EHR users should ascertain where time is being wasted; most systems can show where physician time is being spent in the software.
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Insider threats, human error, ransomware are healthcare's biggest risks, Verizon report says

Healthcare is the only industry where inside threats outnumber outside threat actors, according to Verizon’s most recent breach report.
April 10, 2018 04:48 PM
Ransomware is the most prevalent malicious software in all sectors, found in 39 percent of all malware-related breaches or twice as much as 2017, according to the latest Verizon Data Breach Investigations Report.
It moves from fourth place last year and up from 22nd place in 2014. Hackers are now leveraging the virus to disrupt critical systems instead of a single device to make more in ransoms.
But while ransomware is still a prevalent threat to the industry, healthcare has the most dubious title: The only industry where inside threats outnumber outside threat actors.
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HIT Think Why Facebook privacy concerns should impact HIT’s future

Published April 11 2018, 6:00pm EDT
The recent exposure of Cambridge Analytica’s deceptive and invasive use of Americans’ Facebook information during the 2016 election is causing widespread outrage, and more concern is emerging as the company’s top executive has testified before Congress the past two days.
However, government regulations for healthcare information also could be called into question, and many wonder if a similar incident could happen with data from Americans’ medical records. The Facebook situation provides important lessons around needed safeguards in healthcare IT regulation.
One lesson is that individuals’ consent is not always granted forever; they may someday regret allowing data access down the line, as was the case with Facebook. Current government regulations would still require patients to grant access to their health information, but the Facebook controvery shows the inadequacy of that protection alone.
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Coast Guard to implement same Cerner EHR as DoD

Published April 10 2018, 7:15am EDT
The U.S. Coast Guard will implement the same Cerner electronic health record system that the Department of Defense has so far installed at four military sites in the Pacific Northwest. The two agencies made the joint announcement on Monday.
A branch of the U.S. armed forces, the Coast Guard had been considering both government and commercial-off-the-shelf EHRs as possible solutions to replace its current paper-based records. But in the end, the agency decided to opt for DoD’s system—called MHS GENESIS—that leverages the Cerner Millennium platform.
“The Coast Guard plans to adopt the MHS GENESIS system to all its clinics and sick bays,” said Rear Admiral Michael Johnston, the Coast Guard’s director of acquisition programs and program executive officer. “Approximately 6,000 active duty Coast Guard members receive their medical care and dental care at DoD hospitals and facilities.”
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Specialty EHR Products Tied to Highest Physician Satisfaction

Integration, revenue cycle management, and other specialty EHR service providers continue to rank highest in physician satisfaction.

April 09, 2018 - Specialty EHR product categories were given the highest physician practice satisfaction scores, according to a recent Black Book survey.
Researchers interviewed 18,950 physician practices in client experience and satisfaction and gathered customer evaluations on 340 EHR products.
AdvancedMD, drchrono, Epic Systems, NextGen, NetSmart, Modernizing Medicine, and SIS Amkai received top ratings from Q3 2017 to Q1 2018, in areas such as addiction medicine, cardiology, endocrinology, and nephrology.
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25% of Patients Did Not Access Data Over Patient Privacy Concerns

A recent ONC study found that 25 percent of individuals offered access to their online medical records did not access that information because of patient privacy and security concerns.

April 09, 2018 - The HIPAA Privacy Rule guarantees patient data access as well as patient privacy.  
While both guarantees are important, they can sometimes be at odds. The goal of HHS under the HIPAA Privacy Rule is to ensure patient privacy is protected, while facilitating the flow of healthcare information to legitimate sources. 
That tension is reflected in a recent study by the Office of the National Coordinator for Health Information Technology (ONC) about individual use of online medical records and technology.
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HIT Think Why providers need a cost-conscious approach in buying IT

Published April 10 2018, 5:13pm EDT
Provider organizations have key needs for healthcare IT systems—they should be easy for clinicians to use, improve patient health and should not bankrupt their budgets.
And how is healthcare doing thus far?
The EHRs available today are developing rapidly. Vendors are making frequent and impactful improvements to improve system usability. Clinicians are getting better at maximizing the contribution healthcare IT makes to patient health and safety. It’s not hard to see how healthcare IT can meet the first two requirements and broadly contribute to improved healthcare.
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Health Information Exchange Connects Docs With EHRs During Disaster

Alexandra Wilson Pecci, April 10, 2018
HIE connectivity enabled care for evacuated patients when Hurricane Irma hit.
Hurricane Irma cut a devastating path through the Caribbean and the southeastern United States, leaving 144 people dead and nearly $65 billion in damage in its wake in September 2017.
The terror of such a storm is most certainly magnified for hospitals and health systems, which must continue to care for—and often evacuate—vulnerable patients.   
"During a disaster, chaos is the norm," Phillip L. Coule, MD, MBA, interim vice president and chief medical officer at Augusta University Health System and interim associate dean for clinical affairs at the Medical College of Georgia and Augusta University, told HealthLeaders Media via email.
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NIH completes Pan-Cancer Atlas based on massive genomic analysis

Published April 09 2018, 7:14am EDT
National Institutes of Health-funded researchers have developed an atlas that provides the scientific community with a comprehensive, in-depth and interconnected understanding of how, where and why tumors arise in humans.
The Pan-Cancer Atlas is based on a detailed genomic analysis of molecular and clinical data from more than 11,000 tumors, representing 33 different cancer types. NIH officials contend that the database will serve as an essential resource for precision medicine, enabling physicians to select treatments that are most likely to help patients based on a genetic understanding of their disease.
 “This project is the culmination of more than a decade of groundbreaking work,” said Francis Collins, MD, director of NIH. “This analysis provides cancer researchers with unprecedented understanding of how, where and why tumors arise in humans, enabling better informed clinical trials and future treatments.”
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Testing algorithms key to applying AI and machine learning in healthcare

A physician expert from Partners Connected Health and Harvard Medical School offers tips for healthcare organizations working with advanced technologies.
April 09, 2018 09:44 AM
Artificial intelligence and machine learning systems are gaining a lot of ground in healthcare, with everyone from tech giants like Google and Amazon to startup companies building systems for healthcare provider organizations.
Claims about algorithms beating physicians at their job are made every month. But are all algorithms made equal? Will invest in machine learning result in meaningful gains for an organization?
The Algorithm Science team at Partners Connected Health invests a great deal of time thinking about the right questions, working out potential pitfalls and developing best practices in evaluating machine learning based solutions. Sujay Kakarmath, MD, post-doctoral research fellow at Partners Connected Health/Harvard Medical School, offers advice to healthcare organization CIOs and other IT staff on working with algorithms.
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Millennials demand telehealth in a move away from traditional primary care model

April 04, 2018
It is no secret that millennials are a driving force in society today, and a new survey shows that their demands and behaviors differ from baby boomer and Gen Xers, and could reshape the healthcare industry especially when it comes to primary care and telehealth.
The 2017 Employee Benefit Research Institute/Greenwald & Associates Consumer Engagement in Health Care Survey was conducted online Aug. 10 to Sept. 1, 2017, with participation from roughly 3,560 adults ages 21 tp 64 who had health insurance provided through an employer, purchased directly from a carrier, or through a government exchange. Eighty-two percent of respondents receive coverage through an employer. The sample was weighted to reflect the actual proportions in the population ages 21 to 64 with private, health insurance coverage. 
Generational divides surface between millennials, Generation Xers and baby boomers in how they engage with healthcare providers. The survey results showed baby boomers are more likely than Gen Xers and millennials to have a primary care provider, with 85 percent of baby boomers saying they have a PCP, compared to 78 percent of Gen Xers and 67 percent of millennials.
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EHR-Integrated Tools Help Improve Chronic Kidney Disease Care

Treatment involving EHR-integrated tools and patient engagement strategies are effective in improving areas of chronic kidney disease care.

April 05, 2018 - A quality improvement program combining EHR-integrated tools and patient engagement strategies can significantly improve quality of care for patients with chronic kidney disease, according to new research published in the American Journal of Managed Care (AJMC).
Over a one-year period, Sequist et al. observed 153 primary care physicians treating 3,947 high-risk patients and 3,744 low-risk patients with stage III chronic kidney disease across 13 ambulatory health centers at Harvard Vanguard Medical Associates in Massachusetts. 
As part of the study, participating physicians received a set of EHR-integrated alerts through the practice’s Epic EHR system during office visits. These EHR alerts provided physicians with recommendations for risk-appropriate chronic kidney disease care.
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The cost of a data breach in healthcare averages $717k: 5 report findings

Written by Julie Spitzer | April 06, 2018 | Print  | Email
Healthcare cyber insurance claims comprised 18 percent of all cyber claims submitted in 2017, but they represented 28 percent of total breach costs, according to the annual NetDiligence Cyber Claims Study.
For the report, NetDiligence reviewed cyber liability insurance claims reported across multiple industries and from several insurers to help risk management professionals understand the importance of data security.
Here are five report findings.
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HIT Think Why cloud and connectivity apps are key for improving care

Published April 09 2018, 5:40pm EDT
In his HIMSS keynote address last month, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn't just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable ‘killer apps’ for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
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Enjoy!
David.

Looks Like The ADHA Board Needs A Bit Of A Push Along Again!

Dateline 21-April-2018.

Here is what we see....

Australian Digital Health Agency Board

Either they have nodded off or they have decided not to provide the usual pathetic level of transparency in a halfway timely fashion. Wonder which it is? Over 4.5 months since the last set of papers.

Wonder why? Surely they have done more than a few press releases and the usual swanning around in almost 5 months?

David.

Friday, April 20, 2018

This Is Really Worth A Close Read! I Hope The ADHA Takes Note As Their System Has Many Of The Same Issues!

This appeared a week or so ago.

Will the tech giants ever succeed at e-Health?

Posted on by wolandscat
Amazon, Apple, and Google are all having another go at e-Health. But we have been here before: remember Microsoft HealthVault? It’s still around, and still hasn’t taken off. Google Health went live in 2008, but was retired at end of 2011, due to ‘lack of adoption’.
Fast forward to 2018, and we see Apple, Amazon, Google and Uber making new e-Health plays. Initially each corporation will probably work from its strengths – retail delivery for Amazon, booking for Uber, data for Google, and devices for Apple. In the US at least, some of them will build their own healthcare providers for the workforce, and use the environment as a place to work on next-generation health IT solutions. Some challenges, particularly in the devices area, will undoubtedly see progress – there is no doubt that the tech giants do some things really well.
But I remain sceptical about overall success.
The reason is that big tech doesn’t understand the e-Health problem space. They appear to think it is a computing problem, like managing bank accounts or friend networks or SEO, and a question of just applying better technology. Things they don’t understand include:
  • privacy: the interests of consumers with respect to data in the healthcare space are complicated by the tension of needing open access to health data among current carers and data partners (e.g. pathology labs testing your blood), but strong privacy outside the care loop, including potentially from family, employers, and commercial data users. Not to mention national legislation generally banning the siting of patient data outside the country of residence. The big tech companies don’t have a terribly strong grip on this kind of privacy. Certainly Google would have its work cut out for it to convince healthcare professionals, and Alexa and Siri are enough to make many dubious of claims to data protection by Amazon and Apple.
  • patient records cross enterprise boundaries: the tech giants will no doubt realise that patient data crosses health provider enterprise boundaries, but in their efforts to each be the e-Health solution of the future, they will lock patient data into their own walled gardens, creating a new version of the same problem.
  • ethical data use: as the saying goes in tech, if you’re getting it free, then you are the product. Google is the best known for secondary use of data, although not many people really know exactly what they do with our data – but mining our every purchase, movement, and what we type in browsers is how they earn their vast wealth. Would we trust them to treat our health data differently?
  • semantics: all the tech companies think they can solve everything with corpus mining, machine learning, trained AI algorithms and other brute-force methods of extracting intelligence from noise. Because they are so addicted to brute force computing methods, they don’t think they need to understand the semantics of the any domain. Yet anyone who has used Google translate for 5 minutes will know how far these methods are from anything resembling intelligence or fidelity. Consequently, they don’t even employ the right kind of people to help them understand and construct the kinds of solutions that might help. I therefore doubt they’ll ever learn what an EHR really is, or even get to grips with the sheer scale of content semantics, terminologies or ontologies in the health domain.
  • clinical community: solving the semantics problem, and numerous other challenges in the e-Health space absolutely requires a close relationship with clinical professionals. It’s the only way to find out about clinical processes, information governance, and how exceptional situations are managed. Big tech is starting at ground zero here.
The problem in e-Health is that you have to create coherent, long-term, patient-centric information based on 10’s or 100’s of thousands of domain information elements, underpinned by terminologies and ontologies, and make the resulting records outlast all applications, OSs, DBs and other technology. This is hard to do, because the information is created during complex processes full of exceptions to rules, and routinely crossing enterprise boundaries.
Solving it requires design, and part of that design is to provide a way to formalise the semantics of the domain into artefacts that can be used at runtime in the workplace. But these artefacts can only be built by domain professionals who understand their information and workflow. And that requires advanced tools and model-based engineering.
Read what Tom thinks the outcome will be here:
To me Thomas Beale really nails it and recognises clearly just how complex the task of establishing a clinically useful secondary EHR (myHR) is!
Thanks Tom for dragging together so many of the issues that are vital to success. I really did save the best until Friday with this!
David.