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, June 24, 2018

It Would Be Nice To Have The Facts On Secure Messaging Without The Spin! Look More Closely And We Get Facts And There Is A Long Way To Go! Baby Steps!

This press release appeared last week from the ADHA.

Media release - Industry collaborates to end the era of the fax machine

June 18, 2018
Out of date and unsecure fax machines are being used to share patient information between healthcare providers, despite other sectors discarding them over a decade ago. Not only do fax machines cause frustration for healthcare providers trying to communicate with each other, they can also cause patient harm.
In May 2018, a coroner’s report revealed that Hodgkin’s lymphoma patient Mettaloka Halwala died alone following chemotherapy complications. His medical test results were faxed to the wrong number, which meant his treating haematologist did not receive information that could have saved his life.
Coroner Rosemary Carlin called for the hospital involved to phase out fax transmission of imaging results as a matter of urgency. She said it was difficult to understand why such an antiquated and unreliable means of communication exists at all in the medical profession.
To support the uptake of digital health services, the Council of Australian Governments (COAG) Health Council approved Australia’s National Digital Health Strategy – Safe, Seamless, and Secure. A key priority in the strategy is to end dependence on the fax machine and paper-based correspondence by empowering healthcare providers to communicate with other professionals and their patients via secure digital channels.
On 6 June 2018, key industry participants at a secure messaging industry collaboration workshop agreed to adopt the tools, processes, and standards that have been demonstrated to solve the interoperability problems across secure messaging and clinical information systems.
Through this collaboration, Australia is on track to end the use of fax machines in healthcare, with key industry players agreeing to the next steps to improve secure messaging of patient records between healthcare providers using clinical software.
The meeting was co-chaired by Medical Software Industry Association (MSIA) President Emma Hossack, Agency Chief Operating Officer (COO) Bettina McMahon, and Dr Nathan Pinskier, Chair of the Royal Australian College of General Practitioners (RACGP) Expert Committee – eHealth and Practice Systems, and Chair of the Agency’s Secure Messaging Program Steering Group. Over 50 participants from the technology and healthcare industry also attended.
MSIA President Emma Hossack said that industry is committed to progressing interoperability in secure messaging, as well as more generally across the health sector.
“Health information is stored in diverse health software and frequently needs to be shared. Without interoperability, this information may need to be scanned and faxed or even posted. Not only can this be dangerous but also highly inefficient.
“To share and manage access to health information, we are working towards adoption of agreed compliant messaging standards, conformance at the receiving ends, and a federated approach to directories. This will make health communications more seamless and safe. It will also make it easier for industry to innovate in this area, as digital foundations will be in place,” Ms Hossack said.
Today the Agency and MSIA released a communique with a commitment to support message formats that give healthcare providers flexibility to construct messages and consume content within their clinical information systems. Authentication and the approach to sharing endpoint locations across directories was also addressed.
Proving interoperable messaging in real world projects
This commitment follows good progress with proof of concept projects led by Telstra Health and Healthlink.
Telstra Health is leading a consortium to test the delivery of discharge summaries from Royal Melbourne Hospital to a range of general practitioners. CorePlus, Genie Solutions, Global Health, HealthLink, and Zedmed are also participating in this project.
Telstra Health Head of Strategy and Policy Dr Phuong Pham said enabling providers to reliably connect and securely share information with each other is crucial to support the safety, quality, and efficiency of the health system.
“Telstra Health is proud to be collaborating with industry colleagues and the Australian Digital Health Agency to make interoperable messaging possible. With the proof of concept activity nearing completion, we keenly anticipate the next phase of digital enablement in healthcare,” Dr Pham said.
Healthlink is leading the other consortium and is testing the delivery of referrals from a range of general practitioners to specialists. MedicalDirector, Best Practice Software, Genie Solutions, Global Health, and Telstra Health are supporting this work.
HealthLink CEO Tom Bowden said that he is pleased with the progress to date on the federation of messaging directories.
“The ability to select any practice from a federated directory search will be a major step forward for eHealth across Australia,” Mr Bowden said.
Both consortia are finalising a federated search capability to allow the searching of provider directories and care provider electronic addresses. This means that a single search will identify Australian healthcare providers, providing convenience and transparency for clinicians looking up other clinicians. The sending of messages across these sites will commence this month.
The projects have also been extended to include allied health practitioners and electronic medical record (EMR) products used in that domain. The Telstra Health consortium will enable allied health practitioners to send reports to their referrers and the HealthLink consortium will extend the sending of referrals to and from allied health.
In addition to laying the foundations for national secure messaging, the lessons learnt in this project will inform other industry collaborations as Australian healthcare drives towards full interoperability across digital health systems.
Dr Nathan Pinskier reflected on the progress made with secure messaging in Australia.
“In late 2016, Agency CEO Tim Kelsey visited my practice to obtain a better understanding of the complexities frontline healthcare providers were facing when attempting to utilise secure electronic messaging.
“During the visit, Tim offered me the opportunity to become involved with a new and invigorated secure messaging program. Clinicians have been understandably frustrated with the ongoing delays and lack of progress towards achieving truly interoperable, easy to use and highly available secure messaging in the healthcare sector.
“Well the good news is that as a consequence of the significant work undertaken in the past 18 months we are closer than ever to achieving this vision. I’m looking forward to the outcomes from the proof of concepts and then moving on to national deployment. It has been a privilege to collaborate with industry and all key stakeholders to support this vital piece of national work,” Dr Pinskier said.
Agency COO Bettina McMahon said that the key to solving the interoperability issues has been partnering with industry and their customers.
“Secure messaging systems and standards have been in place for many years, but as a country, we’ve struggled to implement at a national scale. It has taken time to co-produce a workable solution with industry that meets the expectations of the clinical community – we started this project 18 months ago. But to adopt a true co-production process takes this long, and ultimately, has allowed us to reach consensus about how we will scale digital communication,” Ms McMahon said.
ENDS
Here is the link:
Now with all this we need to see – with the communique just where things are – as of June 2018. Unspun it is clear there is a lot of work still to do!
Communique –

Industry Collaboration for Secure Messaging and Interoperability

The Australian Digital Health Agency and Medical Software Industry Association jointly ran a Secure Messaging Industry Collaboration Workshop in Sydney on 6 June 2018 to make decisions on key issues to the progression of secure messaging and interoperability across the health sector.
The meeting was co-chaired by Ms Bettina McMahon Chief Operating Officer, Australian Digital Health Agency, Ms Emma Hossack President, Medical Software Industry Association and Dr Nathan Pinskier Chair of the RACGP Expert Committee – eHealth and Practice Systems and Chair of the Secure Messaging Program Steering Group for the Australian Digital Health Agency.
The meeting was attended by 53 members from clinical and secure messaging software suppliers and stakeholders from industry.
The group discussed a number of items and reached the following agreements:

Message payload

Healthcare providers are requesting their software providers to give them flexibility in the methods to construct messages and consume the content of messages within their clinical information systems. Industry is responding to this call through innovations in the way systems communicate with each other, and how they support clinicians to process and interpret message content.
The Australian healthcare system currently uses messages in HL7v2 and CDA. CDA is used for interactions with the My Health Record, which are increasing in volume and spread across the healthcare system. HL7v2 is used by the pathology labs and clinical software which have high volumes of messages that span across many parts of the healthcare sector.
There is consensus that both standards are in widespread use today and we need to support both.
Challenges in supporting HL7v2.3.1 and HL7v2.4 will be resolved by the version of HL7v2.4 that has been refined by the Technical Working Group and is currently out for comment through HL7 Australia. The standard endorsed through this process will be the HL7v.2 message format to be supported in the medium term.
There is a need to develop tools to test compliance with these standards by sending and receiving systems, and a scheme to manage compliance.
There was broad acknowledgment that work is required to improve payloads to optimise their compatibility with clinical work flows. In particular, there is a need to increase receiver compliance and to engage with the pathology sector in relation to sending compliant messages once receiver compliance has been achieved.

Agree an approach for certificate and trust management

In order to safely share and manage access to information in the healthcare system, it is essential to be able to authenticate users, including organisations and people. This is currently achieved through the use of digital certificates that conform to the Australian Government endorsed Public Key Infrastructure (PKI) standard.
NASH remains the national solution for the authentication of users and certificate management for those wishing to send information to the My Health Record and it continues to support secure messaging across health care providers.
In addition to the continued role of NASH as the national authentication solution there was also majority support for a national trust framework to support those suppliers wanting to use private certificates. This framework will provide the agreements and model required for vendors to trust each other’s certificates. This will also support the issuing of certificates for those organisations not eligible for a NASH certificate.
Although participants provided in principle support for continuing with NASH, participants expressed concern regarding the current system’s responsiveness. NASH does not adequately meet the needs of messaging providers and their customers; both the process to obtain a certificate, the time delay in certificate issue, and the problem rectification process. The Agency is working with the Department of Human Services to improve service levels.
The Agency has agreed that privately issued certificates have a role in secure messaging, where those certificates meet appropriate standards.
It was agreed that the decision to trust non-NASH certificates for secure messaging is one for industry to make with clinical input. The Agency has confirmed that it will facilitate a discussion with industry on a trust framework to provide assurance over the quality of the certificate issuance processes.

Agree the direction for the next phase of provider directory and addressing services

There is a base layer of data about providers that is being collected and maintained in multiple places across the health sector. There is significant duplication to keep this data up to date, and while it is required as a starting point to provide other services, in itself it is a commodity rather than IP.
It was agreed that defining this base level of data and sharing it was the right approach. The organisations present agreed to share this information through the APIs developed through the Technical Working Group and validated through the proof of concepts. This will allow resources to be applied to developing services and products that build on top of this foundation – which presents the ‘value add’ and competitive offering for industry participants.
The model to aggregate and assist the user experience in bringing together a distributed data set was discussed. A proposal was discussed, with feedback that it could be leaner than what was presented, and privacy issues were raised that would need to be worked through.
The Agency agreed to continue to work with industry and healthcare providers on the services that could support the distributed directory model. This will occur in parallel to messaging providers sharing base level data in their provider directories through the APIs already available.

Compliance and governance

Implementing the agreements of the day will require additional activities including:
-          Compliance tools and a compliance regime
-          The right governance at a program and industry level
-          Resourcing and funding support to achieve the vision
Signed etc.
Here is the link:
So there you have it. The facts are.
1. We don’t yet have a messaging standard.
2. We are compromising on message payloads.
3. NASH after many years is still a flop and we need to work out how to use private certificates
4. Overall directory services still need work to be integrated.
5. Compliance and governance need more work.
6. There are still a host of message destinations that are not digital messaging enabled.
We can safely conclude the fax machines are here for a long time to come!
Nice to see the communique was reasonably spin free and clear – as opposed to what the ADHA itself put out – the trust deficit just widens! Also it is good to see industry is working cooperatively - a very good thing indeed which hopefully means, in time, good outcomes will follow!
David.

AusHealthIT Poll Number 428 – Results – 24th June, 2018.

Here are the results of the poll.

On Balance, Do You Believe AI Technology Will Improve Healthcare Capabilities, Safety And Quality Over The Next Few Years?

Yes 12% (16)

Yes - But It Will Take Many Years 85% (117)

No 3% (4)

I Have No Idea 1% (1)

Total votes: 138

As clear cut as it goes – Pretty much every-one says AI is important but overwhelmingly think the impact will take time to emerge! I have to say I am not so sure…..

Any insights welcome as a comment, as usual.

A really, great turnout of votes!

It must have been a very easy question as just 1/138 readers were not sure what the appropriate answer was.

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

David.

Saturday, June 23, 2018

Weekly Overseas Health IT Links – 23rd June, 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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Could Artificial Intelligence Take the Art out of Medicine?

As health care becomes more complex, technological and data-driven, there’s a risk physicians will lose some of their autonomy
By Pamela E. Hepp on June 14, 2018
It has been said that the practice of medicine is both an art and a science. For example, different patients react differently to the same medication for the treatment of anxiety, and what works for one patient will not work for another. It can be a trial-and-error process to find the correct medication and optimum dosage. Why do side effects to medications or complications to treatments arise in some patients and not others? Every patient is unique, and the art of medicine is the component of the practice that addresses such uniqueness with compassion and care. Will artificial intelligence (AI) change all of that?
Of course, medicine is also a science, and health care is no stranger to technology. Health care is and has been for many years highly dependent upon technology, from x-ray machines and laboratory equipment; to more advanced medical equipment such as MRIs, ultrasounds and CT scanners; to systems that dispense medications within the hospital; to electronic medical records.
A hospital’s electronic health record may connect with the electronic health record of other hospitals and physicians to create a “health information exchange” (HIE), so that providers have access to all of a patient’s medical information regardless of where he or she may have been treated. The goal of providing access to a patient’s comprehensive medical information is to decrease medical errors as well as eliminate the provision of duplicate tests or procedures that may occur when a specialist may not have access to another provider’s records.
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HIT Think Why proposed CMS rule will re-energize info exchange

Published June 15 2018, 5:30pm EDT
Federal healthcare organizations such as CMS have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with a “mesh” formed by interoperability requirements and data integration. Many government rules have been written to address the type of mesh needed, and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also, there are issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
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Alphabet's DeepMind asked to explain business model for healthcare

Published June 15 2018, 5:02pm EDT
DeepMind, the artificial intelligence company owned by Alphabet, should explain how it intends to make money from its work with the U.K.’s National Health Service, a review panel appointed by the company concluded.
The panel also said DeepMind’s healthcare division needs to be more transparent about its relationship with the rest of the AI company, with Alphabet and with DeepMind sister company Google.
The public are likely to suspect that there must be an undisclosed profit motive or a hidden agenda without clarity about DeepMind Health’s business model, the panel wrote. “We do not believe this to be the case, but would urge DeepMind Health to be transparent about their business model, and their ability to stick to that without being overridden by Alphabet."
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Next-gen analytics: Here's what's coming in the future

Hospitals should expect orders of magnitude more data – but will also see emerging tools such as artificial intelligence and 5G connectivity helping to put both structured and unstructured information to work.
May 14, 2018 09:11 AM
The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research.
Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.
As the technology continues to grow and mature, here's the pressing question for healthcare and IT leaders: How will analytics tools evolve – and what should they expect to come next?
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The Sequoia Project updates patient matching framework

Written by Jessica Kim Cohen | June 13, 2018 |
The Sequoia Project, a nonprofit focused on healthcare interoperability, released an updated national framework for patient matching June 12.
The framework outlines best practices for patient matching between healthcare organizations and health information exchange partners. The recommendations for improved patient identity management were developed by the The Sequoia Project's Patient Identity Management Workgroup, which comprised stakeholders from academia, industry and government, through a multiyear effort. 
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This 30-second change to your computer settings is the easiest way to stop hackers

Published: June 13, 2018 11:16 a.m. ET

Experts claim you could save millions of dollars from potential hacks with one simple step

It takes less than one minute and can block many kinds of malware.

KariPaul

Reporter
With just a few clicks, you could better arm yourself against hackers and block advertisers from tracking you online.
Cybercrime is projected to cost the global economy more than $2 trillion a year by 2019 according to market analysts Juniper Research, and many of those scams start with phishing — tricking people into clicking on nefarious links through legitimate-looking emails.
An easy way to block these attacks: Change the Domain Name System (DNS) that your computer uses. Most computers connect to the DNS that’s automatically set by their internet service providers, but there are safer alternatives.
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AMA: Medical students, residents receive insufficient EHR training

Published June 14 2018, 7:24am EDT
Medical students and residents are not effectively using electronic health records because they continue to receive insufficient training on the systems as part of their formal professional education.
That’s the contention of the American Medical Association, whose policymaking body—AMA’s House of Delegates—met this week at its annual meeting and adopted a new policy that encourages medical schools and residency programs to “design clinical documentation and electronic health records (EHR) training that provides evaluative feedback regarding the value and effectiveness of the training, and, where necessary, make modifications to improve the training.”
In addition, the nation’s largest physician group wants to see medical schools and residency programs “provide clinical documentation and EHR training that can be evaluated and demonstrated as useful in clinical practice” and to “provide EHR professional development resources for faculty to assure appropriate modeling of EHR use during physician-patient interactions.”
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UCHealth to work with digital health companies to put tech into practice

Published June 14 2018, 7:32am EDT
UCHealth is planning to create an innovation center and work with medical technology start-up companies on artificial intelligence, big data, decision support, virtual health and wearables, among other technologies.
The nine-hospital Colorado delivery system, led by University of Colorado Hospital in Denver, seeks to build off its past experiences in working with innovative companies to improve the efficiency of operating rooms and the accuracy of medication prescribing. New efforts will include injecting new research and protocols into the electronic health records systems and using wearable devices to continuously monitor patient vital signs, executives say.
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Digital health must benefit patient safety

Written by Alojz Peterle on 14 June 2018 in Opinion
European policymakers must work towards better healthcare coordination and support while addressing preventable harm, writes Alojz Peterle MEP.
Patient safety is a major public health issue, with more than a quarter of EU citizens admitting to having an adverse experience while seeking healthcare and over half believing that patients might experience harm while in hospital care.
Unfortunately, there are grounds for such concerns. Every year an estimated 4.1 million patients acquire a healthcare associated infection in the EU and at least 37,000 die as a result.
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Special Report: Medicines Management

With national funding pledges to increase the uptake of e-prescribing in hospitals, digital medicines management is occupying a prominent place on the national agenda. But does that mean it can now finally hold a consistent place across NHS activity in local organisations? Jennifer Trueland investigates.
Digital medicines management seems to be front and centre of the national agenda at the moment. Hot on the heels of a Department of Health and Social Care review and an academic study into medication errors in England, in February health and social care secretary Jeremy Hunt announced £75 million to help NHS hospitals implement e-prescribing systems.
Some might say it’s about time. Although the technology has been around for years, and its benefits well rehearsed – reduced errors, improved patient safety and experience, financial and efficiency savings – uptake has remained gradual. The most recent Digital Health Intelligence clinical digital maturity index (CDMI) report showed 56% of trusts had gone electronic for outpatient prescribing, and 43% had for inpatient prescribing.
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Hospitals investing big in clinical communications as secure texting gains traction

Health system executives are convinced that mobile technology improves patient safety, but are looking for tools that feature robust security features, according to Black Book.
June 11, 2018 03:45 PM
Nearly all hospitals – 96 percent of them – are either budgeting for or already investing in comprehensive clinical communication platforms this year, according to a new report from Black Book Market Research.
C-suite IT decision-makers and frontline clinicians are united in their agreement that smart use of mobile devices makes for better patient safety and improved outcomes (90 and 94 percent of survey respondents, respectively) and the new study shows secure texting is fast-becoming the tool of choice for hospitals and practices.
Among 770 hospital professionals and 1,279 physician practices polled, the report showed respondents were looking for mobile technology that could do the most for patients while also maintaining sound cybersecurity.
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Next-gen data management: From FHIR APIs to AI to genomics, tech is changing fast

Hospitals should also expect Blockchain, patient experience and new iteration of vendor neutral archive capabilities to be available in the future.
June 13, 2018 09:36 AM
Healthcare data management technology is crucial to the interplay of information between IT systems, organizations and caregivers. The technology ensures that the right information is in the hands of the right person at the right time.
While data management tech is one of the basics of healthcare information and technology, it is by no means in an uninteresting position. In fact, there are many factors causing changes to the technology that healthcare CIOs will have to stay on top of in the years ahead.

APIs will decentralize data

The first next-generation feature of healthcare data management technology will be the decentralization of data through the incorporation of APIs into any technology at play within the health system, said Mark Vance, senior vice president of technology at Signet Accel, a data management technology vendor.
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Video Counseling Can "Upskill" PCPs, Bringing Specialty Knowledge to Rural Patients

Ryan Black
JUNE 12, 2018
There’s already ample evidence that telemedicine has great potential for improving outcomes and saving patients and healthcare organizations money. Saving lives, however, is a different proposition.
But not all telehealth is direct-to-patient. Video counseling for providers can act as a force multiplier for medical knowledge. And according to researchers from University of Michigan Medical School and the Ann Arbor Veterans’ Affairs Medical Center, such peer-to-peer videoconferencing might have helped survival rates among a cohort of more than 62,000 patients with liver disease.
Their new report, published in Hepatology, focused on a program called SCAN-ECHO, which stands for Specialty Care Access Network-Extension of Community Healthcare Outcome. The original ECHO program is a videoconferencing program first developed in New Mexico that works to “upskill” physicians by connecting them with specialists to inform care of patients with unique needs (rather than connecting a patient directly with a doctor via video).
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Pagers still a top communication tool in healthcare: 7 survey insights on hospital mobile strategies

Written by Julie Spitzer | June 12, 2018 |
Despite the popularity of smartphones and other mobile communication devices, many hospitals are still using pagers as a main mode of communication — especially among non-clinical care team members — according to a Spok survey.
For its annual "Mobile Strategies in Healthcare" report, Spok surveyed more than 300 healthcare professionals — 44 percent of whom were clinicians — about their organizations' mobile communication methods.
Here are seven survey insights:
1. The majority of respondents (57 percent) said their organization has a mobile strategy in place and 21 percent of them said their strategies have been in place for more than five years.
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Physical records were top target for hackers in Q1 — 8 statistics

Written by Angie Stewart | June 12, 2018 
Hackers breached protected health information most often through physical records in the first quarter of 2018, HIPAA Journal reports. 
Here were the top locations of breached PHI:
1. Paper/films: 18
2. Email: 16
3. Network server: 11
4. Laptop: 10
5. Electronic medical record: 9
6. Other portable electronic device: 9
7. Other: 7
8. Desktop computer: 6
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How CVS Health boosted specialty medication adherence with secure messaging, digital engagement

Jun 13, 2018 12:23pm
For the last year, CVS Health has been slowly integrating new digital tools to improve medication adherence for patients with serious conditions like cancer, cystic fibrosis and multiple sclerosis.
Using its mobile app, secure messaging and analytics, the retail pharmacy chain directed its efforts towards patients on specialty medications. By incorporating information from medication trials, CVS sends users customized alerts about potential side effects that coincide with the timing outlined in the clinical studies.
For example, if a cancer medication typically causes diarrhea three weeks into the regimen, the app times the alert at the three-week mark, and offers immediate access to a live care provider to answer additional questions, either through the app or on a phone call.
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Why a group of health systems just agreed to share precision medicine data with each other

Jun 13, 2018 3:02pm
If precision medicine is really going to be the panacea experts have promised, it'll be because health providers agreed to play nice with each other.
That's why Thomas D. Brown, M.D., executive director of the Swedish Cancer Institute in Seattle, said his organization jumped into a new Precision Medicine Countil convened by tech company Syapse. The council also includes Henry Ford Health System, Dignity Health, Catholic Health Initiatives, Aurora Health Care and the University of Miami Health System. 
Brown, whose institute is a part of Providence St. Joseph Health, said big-name providers that use similar technology systems will be central to building the massive and diverse data sets needed to allow researchers to find useful needles in the proverbial genomic haystack.
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New research shows up to 1,000 patients harmed by medical device breaches

Jun 13, 2018 2:48pm
As many as 1,000 patients suffered harm from medical devices hit by a cybersecurity attack, according to a new survey of executives of device manufacturers and provider organizations.
The survey, conducted by researchers at the University of California San Diego, is scheduled for publication in an academic journal. The results were announced by Christian Dameff, M.D., an emergency physician and clinical informatics researcher at UCSD at the HIMSS Healthcare Security Forum this week.
Of the 40 executives from some of the largest medical device vendors and provider organizations, two said 100-1,000 patients were harmed during an unreported adverse event associated with a medical device cybersecurity vulnerability.
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HIT Think 4 keys to successful health IT integration

Published June 13 2018, 5:52pm EDT
My career in medical informatics has spanned more than 15 years. During that time, I have witnessed innumerable changes in the processes, technology and people related to health IT solutions.
It used to be that the focus was almost entirely on clinician adoption, even if it adversely impacted outcomes and value. Clinicians and health systems were certain that they and their patients were unique, and process standardization and decreasing variations in care was only the dream of a few.
We certainly have come a long way from those early days. Today, most healthcare leaders are united around the belief in open, interoperable technology, and that standardization within an organization and across the industry is necessary if we are committed to improving the health outcomes of patients.
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Machine learning predicts dangerously low blood pressure during surgery

Published June 13 2018, 7:29am EDT
A machine learning algorithm is able to predict potentially dangerous low blood pressure that can occur during surgery by detecting subtle signs in routinely collected physiological data in surgical patients.
Dangerously low blood pressure—hypotension—can lead to complications such as postoperative heart attack, acute kidney injury and even death. The algorithm was able to accurately predict an intraoperative hypotensive event 15 minutes before it occurred in 84 percent of cases, 10 minutes before in 84 percent of cases, and five minutes before in 87 percent of cases.
Researchers leveraged two datasets to build and validate the predictive algorithm, based on recordings of the increase and decrease of blood pressure in the arteries during a heartbeat—including episodes of hypotension. For each heartbeat, they were able to derive 3,022 individual features from the arterial pressure waveforms, producing more than 2.6 million bits of information used to build the algorithm.
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Despite AI ethical concerns, IoT and smart sensor investments on rise new report finds

Most healthcare execs are planning to buy AI and IoT technology, but they'll need other capabilities and competencies to ensure they're safely deployed.
June 12, 2018 09:19 AM
It won't surprise you to know that artificial intelligence and the internet-of-things are suddenly big business. But as hospitals and health systems rush to incorporate these new technologies, many don't realize that they also need to be honing other capabilities and competencies – and sometimes buying complementary technologies – to ensure AI and IoT are well-deployed.
Accenture's new report, Digital Health Technology Vision 2018 finds that more than three-quarters of healthcare decision-makers surveyed say they're planning to invest in IoT and smart sensors in 2018. And more than half said they're shopping around for AI systems. The vast majority (86 percent) said they're looking for technology to help them harness data to drive automated decision-making.
At the same time, many are beginning to realize that the fundamental changes represented by AI demand more than just buying and installing a particular piece of software. More than 80 percent of execs said they're not ready for "societal and liability issues that will require them to explain their AI-based actions and decisions," according to the report.
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Radiologists find 13-button mouse useful for everyday tasks

Radiologists are completing more exams with fewer resources—thanks, in part, to new technology increasing personal efficiency.
When one institution gave radiologists a programmable 13-button mouse over a two-day period, many preferred non-conventional device over the conventional three-button variety, according to a study published in the Journal of Digital Imaging.
“In an era of decreasing radiologist reimbursement and increasing exam volume and complexity, it is imperative that radiologists explore multiple options to optimize workflow efficiency to meet the future demands of the specialty,” wrote lead author Kevin Denton, with the Department of Radiology at the University of Kansas Medical Center and colleagues.
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How Web-Based EHR Systems Save Community Hospitals Money

The flexible contracts that accompany some web-based EHR systems can fit a community hospital’s tight budget.

June 11, 2018 - More and more health IT companies are working to develop affordable EHR system offerings geared toward meeting the needs of small, rural, and community hospitals.
Enterprise health IT companies such as Epic and Cerner — which formerly catered almost exclusively to large hospitals and health systems — now offer deployment models and cost-efficient product packages better able to fit within the bounds of a small hospital-sized budget.
The advent of the web-based EHR system has allowed for even greater savings. Web-based EHR systems eliminate the need for cost-conscious hospitals to make upfront capital investments in new hardware or in-house storage systems.
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81% of healthcare execs say they're not prepared for potential social, liability issues of AI

Written by Jessica Kim Cohen | June 11, 2018 
As healthcare executives adopt artificial intelligence tools at an unprecedented scale, many have begun to realize they must prepare for the potential social or liability issues automated decision-making may create, according to an Accenture report.
For the report, the professional services company surveyed C-suite executives from 100 healthcare organizations about their firm's technology adoption and investment.
Here are five survey insights into how healthcare executives are adopting AI:
1. Fifty-three percent of executives plan to invest in AI systems, with 86 percent of respondents indicating their organizations use data to drive automated decision-making at an "unprecedented scale."
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One-third of healthcare CIOs 'still on the journey' to comply with GDPR privacy rules

Written by Jessica Kim Cohen | June 11, 2018 |
Roughly half of healthcare CIOs — 53 percent — indicated they would be 80 to 90 percent in compliance with the European Union's General Data Protection Regulation by May, according to a joint survey by IT outsourcing service provider Harvey Nash and professional services firm KPMG.
The EU's new data protection rules, which went into effect May 25, apply to anyone who handles European citizens' personal information, including addresses, credit card numbers, biometric data and other information that may be traced back to an individual. The law, which is stricter and broader than HIPAA, will affect businesses of all sizes worldwide that use European citizens' data in their services.
To assess IT leadership's preparedness for GDPR compliance, Harvey Nash and KPMG surveyed nearly 4,000 CIOs and technology leaders across 84 countries about their journey to meet the EU's new rules. Although the majority of healthcare respondents said they would be mostly prepared by May, only 14 percent expected to be completely in compliance.
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HIT Think 4 tips for retaining key IT staff talent

Published June 12 2018, 5:39pm EDT
While recruiting in-demand IT professionals is difficult, the real challenge is figuring out how to retain those professionals. It’s not an easy problem to solve, but it’s possible and worth it when adding up just how much high turnover can cost a healthcare organization.
In the tech industry, it’s rare to see employees stay with one organization longer than two years. Consider these four HIT professional retention tips as helpful insights into the minds of your most valuable employees.
To get essential software, app or web development talent, HIT executives most likely must consider the average salary ranges, benefit plans and additional incentives competitors were offering for the developer roles they wanted to fill. This research shouldn't end once the position is filled.
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Groups seek to develop atrial fibrillation decision tools

Published June 12 2018, 5:33pm EDT
The Patient-Centered Outcomes Research Institute and the American Heart Association have teamed to build a new research center to create or refine “decision aid tools,” a type of decision support, to help patients with atrial fibrillation more easily make choices on their treatment options with their physicians.
Two decision aid support tools are being developed—the first is for patients with atrial fibrillation to use on their own before an office visit, with the second tool to be used with the doctor during the visit.
“Shared decision making tools can be very useful in helping patients, their families and their clinicians better understand and discuss how to balance the benefits and risks of their treatment options,” says Joe Selby, MD, an executive director at PCORI.
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Apple Health Records API owes much to FHIR standard

Published June 11 2018, 7:15am EDT
Apple’s new Health Records API—offered to developers to help them create apps for better disease management, medication tracking and nutrition planning—would not be possible without HL7’s Fast Healthcare Interoperability Resources standard.
So said Jason Morely, software engineer on the Apple health team, during the company’s 2018 Worldwide Developers Conference held last week in San Jose. At the event, the company announced the availability of the Health Records API, enabling developers to access healthcare data and “work with it,” resulting in the creation of apps that empower patients.
 “Users interact with multiple healthcare institutions over the course of their lives—and, these are often running different electronic health record systems that don’t always represent data in the same way,” Morely pointed out. “This makes interoperability incredibly difficult.”
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Most Clinical Trial Participants Support Health Data Sharing

New research shows 93 percent of clinical trial participants are willing to support health data sharing for a variety of uses.

June 08, 2018 - The vast majority of clinical trial participants approve of health data sharing among researchers as long as the appropriate safeguards are in place, according to new findings in the New England Journal of Medicine (NEJM).
Despite the high number of patient EHRs compromised in healthcare data breaches in 2018, few patients have reservations about allowing university scientists or for-profit companies to access their health data.
According to Mello et al., only 8 percent of a total number of 771 surveyed clinical trial participants feel the potential negative consequences of data sharing outweigh the benefits.
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CMS: Medicaid programs can fund opioid-related health IT enhancements through HITECH

Jun 11, 2018 4:02pm
Federal funding is available to state Medicaid programs to enhance the use of technology to help states manage the opioid crisis, according to new guidance from the Centers for Medicare & Medicaid Services (CMS).
Much of that funding is already available through existing legislation, the agency said. The guidance also encourages Medicaid program directors to use telehealth and telepsychiatry to coordinate care for patients with substance abuse disorder.
In a letter (PDF) to state Medicaid directors, Tim Hill, acting director of the Center for Medicaid and CHIP Services, said the CMS doesn’t need to approve telehealth coverage changes for opioid treatment unless the state elects to cover telehealth encounters differently than in-person visits.
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6 key criteria for selecting business analytics tools

Published June 11 2018, 7:32am EDT
Key capabilities needed in business analytics tools
The adoption of business analytics doubled between 2013 and 2016, according to the BARC Research and Eckerson Group study, “BI and Data Management in the Cloud: Issues and Trends.” The most popular tools are those that are designed to improve data exploration, including visual discovery. Additional factors that differentiate cutting-edge business analytics tools include extensive support for dashboard reporting (mentioned by 76 percent of respondents), ad-hoc analysis and exploration (noted by 57 percent) and dashboard authoring (55 percent). Dozens of new analytics tools are released every year, making it difficult to select the best choice for any organization. Blogger Louis Columbus of SelectHub aims to simplify the process by identifying six key criteria to use in making a selection.
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Latvian Association of Family Physicians issues call not to vote for Greens/Farmers and their health care policy

RIGA - The Latvian Association of Family Physicians at the meeting on Friday supported a call not to vote for the Union of Greens and Farmers and the bloc's healthcare policy.
The association's president, Sarmite Veide, told LETA that the family physicians thought that Health Minister Anda Caksa (Greens/Farmers), Prime Minister Maris Kucinskis (Greens/Farmers) and the political bloc they represented would reduce the health care system to shambles, leaving "doctors and patients staring at broken pieces".
The family physicians agreed to re-assess performance of the e-health system in July. As long as the functions of issuing e-sick notes and e-prescriptions did not work properly (namely, if it took physicians more than 30 seconds to issue one of those electronic documents), the family physicians will not be using other functions of the e-system. Moreover, they will abstaining from use of the e-health system one day a week.
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Enjoy!
David.

Friday, June 22, 2018

Some Interesting Questions Worth Thinking About Around AI In Healthcare.

This appeared a few days ago.

Could Artificial Intelligence Take the Art out of Medicine?

As health care becomes more complex, technological and data-driven, there’s a risk physicians will lose some of their autonomy
By Pamela E. Hepp on June 14, 2018
It has been said that the practice of medicine is both an art and a science. For example, different patients react differently to the same medication for the treatment of anxiety, and what works for one patient will not work for another. It can be a trial-and-error process to find the correct medication and optimum dosage. Why do side effects to medications or complications to treatments arise in some patients and not others? Every patient is unique, and the art of medicine is the component of the practice that addresses such uniqueness with compassion and care. Will artificial intelligence (AI) change all of that?
Of course, medicine is also a science, and health care is no stranger to technology. Health care is and has been for many years highly dependent upon technology, from x-ray machines and laboratory equipment; to more advanced medical equipment such as MRIs, ultrasounds and CT scanners; to systems that dispense medications within the hospital; to electronic medical records.
A hospital’s electronic health record may connect with the electronic health record of other hospitals and physicians to create a “health information exchange” (HIE), so that providers have access to all of a patient’s medical information regardless of where he or she may have been treated. The goal of providing access to a patient’s comprehensive medical information is to decrease medical errors as well as eliminate the provision of duplicate tests or procedures that may occur when a specialist may not have access to another provider’s records.
Access to all of that information, however, is creating an information overload for many physicians—yet under the current reimbursement system, where providers are paid a set fee per patient encounter or procedure, providers are being pressured to see more patients in a given day, thereby having less time to spend on any given case. Similarly, hospitals are paid a set amount for the entire hospital stay for a specific patient diagnosis. Accordingly, hospitals are incentivized to discharge patients much quicker than they once did.
Lots more here:
This is a fascinating post, written from a legal perspective, that raises all the issues of liability, responsibility, regulation and complexity associated with the use of AI in support of care delivery.
We have already had a taste of the problem with ‘alert fatigue’ from clinical decision support systems (CDS) but as the complexity and capabilities of AI improve it is clear things are going to become that much harder and more tricky.
How responsibility and blame will be apportioned when things go wrong using systems that the users don’t fully understand is an interesting and open question.
Well worth a browse and a think about.
David.