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 02, 2019

The ADHA Comes Clean At Last - They Have A Potential End-Point Security Problem With The My Health Record.

A few days the ADHA issued a briefing on Ransomware:
The guts of the contents were as follows:

Preventing And Recovering From Ransomware.

Summary
Ransomware is a type of malicious software that denies access to computers and files and demands that affected organisations make a payment to regain access to their information. CryptoLocker is a particularly virulent and widely known form of ransomware that encrypts all files located within the infected computer, its shared network drives, and any attached storage.
A ransomware attack on a healthcare organisation can potentially cause significant reputational damage, clinical safety risks, financial harm, and impact to continuity of business operations. Any network connected system could be affected, such as: desktop computers; clinical, personnel or financial information systems; databases containing digital health records; or medical devices.
Ransomware, which has become increasingly common within the health sector, may pose a significant risk to the security and privacy of individual health information and impede organisations’ ability to deliver healthcare services. Depending on the access obtained, an attacker could also read, modify, export or publicly release digital health records.
The comparative prevalence of ransomware in the health sector was highlighted in the Office of the Australian Information Commissioner’s Notifiable Data Breaches Quarterly Statistics Report for the period October to December 2018. The percentage of ransomware-related data breaches reported for the health sector was twice that of other organisation types. It is vital that organisations in the health sector understand their risks and are prepared to prevent and respond to ransomware attacks.
Key points
1. Given that organisations in the health sector have professional and legal obligations to protect health information, it is important that accountable senior managers understand how the risk posed by ransomware is being managed within their organisation and determine if the risk mitigations are acceptable. Suggested questions to ask your ICT team include:
·         Have existing security controls within the organisation been reviewed in light of the risk posed by ransomware? If so, what was the outcome? What is the level of risk and is it acceptable?
·         How are backups of critical systems managed and secured? Will this approach prevent backups being compromised by ransomware? When was the backup process last tested and what was the outcome?
·         What approach is taken to ensure known security vulnerabilities are addressed? Are there additional mitigation strategies that should be implemented, such as those outlined in the Australian Digital Health Agency’s publication ‘Patching: Protecting healthcare information by updating systems and software’?
·         Does the ICT team need additional support or resources to better manage and mitigate the organisation’s risks? Are there additional mitigation strategies that should be implemented, such as those listed in the companion document, Preventing and recovering from ransomware - a briefing for IT Professionals?
2. Ideally, the risks posed by ransomware and other malware should be managed as part of a comprehensive information security framework or in accordance with an appropriate information security standard. There are a number of information security frameworks and standards, which organisations  in the health sector can use to improve the security and resilience of their digital health systems and help meet their professional and legal obligations to protect health information.
3. If your organisation doesn’t have the resources or expertise to assess its risks or to implement adequate security measures, it is recommended that you seek professional advice from a reputable IT service provider or information security consultant.
4. If ransomware does compromise your organisational systems, please note the following:
·         Paying attackers is not recommended as this will encourage further attacks and does not guarantee that organisations will be able to recover affected files or avoid a data breach. It is suggested that you seek legal advice if paying the ransom is considered necessary.
·         Government agencies and businesses covered by the Privacy Act 1988 (Cth) will need to report individual health information breaches under the Notifiable Data Breaches Scheme. Refer to advice from the Office of the Australian Information Commissioner (OAIC) for details.
·         If systems used to access or update the My Health Record system are compromised, it is possible that the security or integrity of the My Health Record system has also been compromised. For any event or situation where there is a suspected or actual data breach relating to the My Health Record system, organisations are required to notify the Australian Digital Health Agency, (the System Operator) and the OAIC.
Here is the link to the .pdf.
Before commenting on the comments above it is important to realise this a live threat.

40% of Health Organizations Suffered WannaCry Attack in Past 6 Months

A report from Armis found that two years after WannaCry, healthcare and manufacturing organizations are still being impacted due to unpatched, legacy devices.
May 30, 2019 - More than two years since the WannaCry attack wreaked havoc across the world, the malware is still impacting devices with 40 percent of healthcare organizations suffering a WannaCry attack in the past six months, according to a report from Armis, a security firm.
WannaCry is a ransomware cryptoworm that struck on May 12, 2017, infecting 300,000 computers globally in just a few short days. The hackers leveraged the EternalBlue exploit developed by the NSA, leaked a few months before the attack. While Microsoft released a patch for vulnerable systems months before the attack, many organizations did not apply it.
As a result, the exploit allowed the virus to proliferate, claiming the UK National Health Service as one of the hardest hit victims. A researcher found a killswitch that prevented the malware from spreading, which stopped the cyberattack in four days.
Lots more here:
Two things strike me about this document:
1. We know from a recent audit in Victoria health organisations are pretty hopeless at security:
See here:

Auditor-General hacked into hospitals to expose online security flaws

By Adam Carey
May 29, 2019 — 2.34pm
Victoria’s Auditor-General successfully hacked into the IT systems of some of the state's biggest hospitals and accessed sensitive patient data, exposing serious cybersecurity weaknesses in the health sector.
Patient data was accessed by government auditors who used basic hacking tools to breach security systems at the Royal Children’s Hospital, the Royal Victorian Eye and Ear Hospital, Barwon Health and sections of the Department of Health and Human Services.
The audit has exposed poor cybersecurity systems among Victorian health service providers, including agencies with weak passwords that can easily be hacked and even one that used default account names and passwords set by manufacturers, which can be found on the internet, to protect patients’ personal data.
In many cases, hospital cybersecurity systems were undermined by poor staff training. Staff were found to be vulnerable to common “social engineering” techniques that cyber criminals use, such as phishing and tailgating into corporate areas where servers are located.
Auditor-General Andrew Greaves wrote in a report tabled in state parliament on Wednesday that all four health services he audited were vulnerable to attacks that could steal or alter patient information.
Lots more here and in the weekly summary:
2. The ADHA admits the are risks to the myHR from infected systems that are connected to the myHR.
One wonders where the effective plan is to really mitigate the risk to the myHR or are we seeing a head in the sand approach. Having all these endpoints connected to a central server was never a great idea. This risk shows how unwise it was – and the ADHA admit they know it.
David.

Breaking News - Chris Bowen To Be The Shadow Health Spokesman In Labor Opposition Cabinet!

I wonder what he thinks of the #myHR?

Ms King (the former spokesman) moves to Infrastructure,  Transport and Regional Development.

David.

AusHealthIT Poll Number 477 – Results – 2nd June, 2019.

Here are the results of the poll.

Given The New Zealand Government's Decision To Abandon Plans For A Centralised National EHR Is Australia Becoming More And More Out Of Touch With Current Digital Health Plans / Trends In Not Rethinking The #myHR?

Yes 95% (82)

No 2% (2)

I Have No Idea 2% (2)

Total votes: 86

Well that was pretty clear – most think the ADHA is a technical dinosaur and is becoming out of touch and irrelevant.

Any insights on the poll welcome as a comment, as usual.

A more than reasonable turnout of votes.

It must have been a slightly hard question as 2 /86 readers were not sure what the appropriate answer was.

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

David.

Saturday, June 01, 2019

Weekly Overseas Health IT Links – 1st June, 2019.

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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Guy’s and St Thomas’ issues £175m tender for new EHR

Guy’s and St Thomas’ NHS Foundation Trust is on the hunt for an electronic health record (EHR) after publishing a tender worth £175million.
Hanna Crouch 23 May 2019
The contract includes a requirement for GPs to have direct access to the EHR as well as having the option of linking up to King’s College Hospital NHS Foundation Trust and possibly Royal Brompton and Harefield NHS Foundation Trust.
The tender also reveals the duration of the contract is initially 120 months but there is an option for a contract renewal.
It says: “Individually, these systems are well-established and used by staff as the primary application for their purpose. However, collectively the core applications provide differing capabilities in support of the day-to-day clinical and operational processes, which results in data not being integrated and managed as a single dataset.
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May 20, 2019

For health and wellness technology, older adults want to learn from healthcare professionals

Unlike with other types of technology, older adults still “rely heavily” on physicians and other healthcare professionals for information about health and wellness-related technologies, according to a new survey.
“Because it has to do with their health care (in their minds), it must be learned from their Health Care Professional AND paid for by someone else, be it private insurance, Medicare or Medicaid,” wrote the authors of the “2019 Technology Study” by Link•Age Connect, a Cincinnati-based research consultancy working exclusively with older adults.
The organization in February surveyed 1,105 people aged 55 or more years. Approximately 19% of respondents lived in affordable housing, and 45% lived in senior housing communities.
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Consumer Use of Online Medical Records Has Plateaued

May 23, 2019
For several years now, CMS has worked to get patients interested in and engaged with the contents of their medical records. Most recently, this has included an effort asking consumers for stories on how accessible their medical information is, as part and parcel of the agency’s MyHealthEData initiative.
Despite all of this work, however, recent data suggests that consumer interest has plateaued over the last couple of years, with what seems to be a substantial number seeing little value in accessing such data for themselves.
According to a new report released this month by ONC, the rate at which individuals access their medical records, as well as the frequency of viewing, remained flat throughout 2017 and 2018.
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Bridging the Digital Divide at the Point of Care

May 23, 2019
Electronic Health records do not always give the data to physicians at the point of care that would help them give better patient care and save money.
Translation Errors Impede Understanding
The problems in interoperability are akin to code on the backend of GoogleTranslate: The system has incomplete logic, due to the fact that languages have idiomatic expressions and thus words sometimes don’t translate directly. For instance, in the German language, nouns have genders. This creates a challenge for translation systems, particularly in ones that go back and forth. The data will get translated to the appropriate gender into German–but then if the data (or in this case, the phrase you want translated) are passed back to English, the gendered nouns can create some strange translations.
With healthcare data, we don’t just need a system that is able to read the words–we need a system that knows when one of the languages has articles, or gender, and the other does not. We also need a system that knows context. In English we say, “great minds think alike.” In German they say “zwei dumme eine Gedanke,” or “two dummies, one thought.”
What do two idiots have to do with your electronic health records? Well, if you don’t know that the idiomatic expression in German is that “two idiots have one thought,” you don’t realize that saying “two minds” has a negative connotation.
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How to Improve Your Small Business's Cybersecurity in an Hour

By Bennett Conlin, Writer May 23, 2019 07:00 am EST
Statistics show that cybersecurity is a legitimate threat to small businesses, but small businesses don't always act on that knowledge. According to the 2018 Hiscox Small Business Cybersecurity Report, 47% of small businesses experienced an attack in the past 12 months. Cybersecurity is a serious concern, yet the report shows only 52% of businesses have a cybersecurity strategy.
Why don't small businesses care about cybersecurity? It's not fair to assume that small businesses truly don't care about it, but they do often ignore cybersecurity concerns. Even with alarming statistics and articles on cybersecurity tips for businesses available, smaller firms seem to consistently overlook the risk of cyberattacks.
Logically, this makes sense. While cybersecurity threats can be as bad as physical security threats, the threats aren't always obvious. While bad password protection and poor site maintenance may leave your business vulnerable to attack, there isn't the same clear threat as there is when you leave your store unlocked or someone is suspiciously walking around your business.
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Most HIMSS Stage 4 hospitals fail to realize EMR benefits years after designation, report finds

Jackie Drees - Print  | 
Most U.S. hospitals that reach Stage 4 on HIMSS Analytics' EMR Adoption Model do not experience EMR benefits they anticipated, even five years post-certification, according to a Chartis Group report.
The eight-stage EMR adoption model, which was developed by Healthcare Information and Management Systems Society subsidiary HIMSS Analytics, runs from Stage 0 to 7 and measures the degree to which a hospital uses its EMR functions. Hospitals receive scores based on standards including digital imaging, interoperability and data security.
Some of the most commonly reported EMR benefits include reduced drug use and costs, increased billings related to charge capture and coding, reduced hospital lengths of stay, accelerated cash collections and improved preventive care, according to the report.
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Transforming healthcare systems the European way

May 24, 2019 04:39 AM
EPRs of Central European healthcare systems are transforming towards IHE infrastructures and thus interoperability. Some are pretty advanced already. In others, progress is painstakingly slow.
It has been a number of years already since the European Commission embarked on a journey of bringing interoperability and international standards to help with digitising European healthcare systems. Way ahead of other parts of the world, the European epSOS project started to define a European patient summary based on international standards a decade ago.
Since then, the European patient summary has evolved beyond Europe and has found its way into the global endeavour to develop an “International Patient Summary” or IPS. The IPS, coordinated by CEN/ISO, is one of the most ambitious interoperability efforts with a clearly international agenda worldwide.
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AMIA to ONC on interoperability rules: 'Share now, standardize as needed'

May 24, 2019 02:37 PM
The informatics group calls on ONC to "flip the paradigm" of consumer access as it finalizes the "most consequential health informatics policies" since meaningful use.
The American Medical Informatics Association is generally pleased with the proposed interoperability rules put forth by the National Coordinator for Health IT. But the informatics group is warning against overly prescriptive interpretation of the 21st Century Cures Act's aims for data exchange.
WHY IT MATTERS
In comments submitted to ONC this week, AMIA said it's wary that ONC might "solidify a dynamic where health data must be standardized before it is available for patient care or research."
Instead, called on the agency to "flip the paradigm" that currently calls for rigidly standardized data for interoperability. ONC's rules should ensure that health data – which will only grow more diverse and come from more sources in the years ahead – can be exchanged first and normalized later, said AMIA.
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Opioid intelligence tools helping hospitals make safer Rx decisions

May 24, 2019 09:12 AM
Technologies to give physicians the ability see PDMP data within their EHR workflows are enabling them to spot doctor shoppers and make smarter prescriptions, says KLAS.
U.S. health systems are availing themselves of prescription intelligence software to ensure they're not overprescribing opioids, or prescribing them to people who shouldn't have them.
A new report from KLAS takes stock of the marketplace and finds that, regardless of which vendors they choose, hospitals are finding quality and safety benefits with the EHR-linked tools – and improving the effectiveness of opioid stewardship programs that in many cases didn't exist even a few years ago.
WHY IT MATTERS
For the report, KLAS surveyed providers to get their opinions of leading prescription intelligence vendors, including AffirmHealth, Appriss Health, Collective Medical Technologies, DrFirst and PastRx.
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Health IT-Related Patient Safety Problems Seldom Resolved

May 22, 2019
In theory, health IT solutions are put in place to prevent errors from taking place, but sometimes they’re actually the cause of the error. Worse, in many cases these HIT-related safety problems are never resolved, according to a new research paper.
The study, which was conducted by three researchers with the National Center for Human Factors in Healthcare at Medstar Health, relied on a database of 1.7 million patient safety event reports. Researchers filtered the data to identify events related to health IT issues.
Once the HIT-related safety events were identified, the research team then reviewed and coded these events as falling into one of four categories: No Resolution, Training/Education, Policy or Information Technology-oriented solution.
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21 May 2019 News

Ransomware Not Gone but More Targeted, Report Says

Kacy Zurkus News Writer

Cyber-criminals continue to grow more sophisticated, developing advanced attack methods, including tailored ransomware, according to the Q1 Global Threat Landscape Report, published today by Fortinet. In addition to targeted attacks, criminals are also using custom coding, living-off-the-land (LotL) and sharing infrastructure to maximize their opportunities, the report said.
Despite a decline in previous high rates of ransomware, ransomware itself is far from gone. Instead, cyber-criminals are using more targeted attacks. Ransomware “is being customized for high-value targets and to give the attacker privileged access to the network. LockerGoga is an example of a targeted ransomware conducted in a multi-stage attack. There is little about LockerGoga that sets it apart from other ransomware in terms of functional sophistication, but while most ransomware tools use some level of obfuscation to avoid detection, there was little of it used when analyzed,” the report said.
Researchers also detected an uptick in malicious actors leveraging dual-use tools, preinstalled on targeted systems to carry out cyber-attacks. 
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PCPs Discuss but Don't Document Social, Emotional Health

EHR Data Is Often Incomplete, Researchers Find

May 21, 2019 01:32 pm Sheri Porter – Researchers at Ohio State University in Columbus and OSU's Wexner Medical Center in Grandview have tackled a topic that will resonate with nearly all practicing family physicians: the art of documenting key components of a patient office visit in the EHR.
Specifically, the authors of a new study report set out to compare the content of recorded office visit conversations between physicians and their patients with the documentation entered into the patient's medical record. With a limited amount of time for each visit and many topics to discuss, exactly how do physician prioritize what is keyed into the patient's electronic record?
Research results are highlighted in an article titled "Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study" that was published in the February issue of Applied Clinical Informatics. Nonsubscribers to that journal can access a research abstract online.(www.thieme-connect.com)  
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Shared decision making in the era of digital transformation

With health and care systems being subjected to significant changes associated with digital transformation, Charles Alessi and Richard Barker explore their implications for the future of medical care.
May 21, 2019 03:07 AM
Health and care systems are changing rapidly. These changes are in part being driven by the pathway redesign that accompanies digital transformation but there are other significant factors that are being brought into play. Medicine itself is changing, as new diagnostic tools enable greater personalisation of treatment, the number of therapeutic options multiply and digital monitoring of individual patients becomes a reality. People have become more assertive and assured in their expectations of delivery of services in many walks of life, and this consumer revolution is beginning to make its impact in the health and care system. This is facilitated by a democratisation and ready availability of medical information, as a direct result of the digital revolution, as we recently proposed in the HIMSS Insights eBook.
Furthermore, people are now starting to directly access - and in places control - their own health data and this of course empowers them to become even more involved in their own care. While all these developments are positive in that they tend to lead to a more “activated and engaged” patient, there are also some potential downsides. The availability of information is one of the greatest benefits from the use of the internet, though information does not equate to knowledge. The fact that a patient has downloaded every possible article about a condition, from whatever source, does not necessarily mean that they have the ability to sieve through a whole series of often conflicting views and determine optimal pathways of care and therapeutic interventions.
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HIT Think Payers, providers jointly benefit from SDOH efforts

Published May 23 2019, 5:38pm EDT
Since the Affordable Care Act first came to the American stage, great strides have been made to make healthcare accessible. Now, healthcare policymakers are turning their focus to healthcare affordability.
Despite ongoing efforts to make healthcare affordable, costs continue to rise. What other levers could be moved to make a difference in healthcare costs? The answer is to look further upstream to the social determinants of health.
We see four key drivers of healthcare costs that providers and payers are focused on: affordable coverage, healthcare accessibility, healthcare usage and patient journeys. Understanding these four drivers explains why providers and payers have paid so much attention to transforming operations in acute care and inpatient settings.
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AI-infused medication review tech cuts review time in half, slashes interactions

Inland Empire Health Plan and Preveon clinical pharmacists use review system to achieve a 50 percent drop in drug-drug interactions, a 50 percent drop in duplications, and two meds discontinued per patient, on average.
May 22, 2019 03:05 PM
Inland Empire Health Plan in Rancho Cucamonga, California, is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire, a metropolitan area in Southern California.
THE PROBLEM
Comprehensive medication reviews, a significant utilizer of trained clinical pharmacist resources, were not focused on plan members most in need, and the review process was manual and time-consuming. Moreover, it was unclear if member outcomes were improving because of this program.
PROPOSAL
Preveon is a specialty pharmacy focused on chronic disease management. Inland Empire Health Plan has outsourced its medication review process to Preveon for its MyMeds Program, and as such, purchased Surveyor Health licenses and allocated them to Preveon. The Preveon team members serve as the end users of the platform from Surveyor Health, an AI-enabled healthcare technology company.
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Healthcare in 21 years will be driven by 'radically interoperable data'

Deloitte's view of the future: empowered consumers taking advantage of open, secure platforms that intermingle disparate information for care coordination and wellness "nudges." Now we just need to get there.
May 21, 2019 04:15 PM
As we focus this month on the promise and potential of digital transformation across healthcare, it's encouraging enough to take stock of the huge advances that have already been made in the past decade of the post-EHR era.
But as we all know, there's a still plenty of room for innovation and improvement as patients and providers look to take advantage of the rich profusion of data that already exists and is growing near-exponentially.
A major impediment, of course, is interoperability. But progress is being made, and momentum seems to be picking up speed – particularly as CMS and ONC prepare to finalize some era-defining rules they say will finally compel some of healthcare's most foot-dragging entrenched interest to embrace data exchange and empower consumers.
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Estimated Revenue Share of International Acute Care EHR Vendors

May 21, 2019
Signify Research has just shared a report that estimates the 2018 revenue share of Acute Care EHR in the EMEA (Europe, Middle East, and Africa) market. The estimate the EMR/EHR IT market in that international region to be worth $3.7 Billion in 2018 (includes both acute and ambulatory applications).
The market share of the EHR vendors working in Europe, the Middle East, and Africa is quite interesting:
Unlike the US market which is dominated by a couple players, the Acute EHR market internationally is much more diverse with Cerner being the only vendor breaking double digit market share. Agfa Health is close, but the report notes that Agfa is looking to sell that piece of its business.
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Data Security: Think Beyond the Endpoint

A strong data protection strategy is essential as data moves across endpoints and in the cloud.
5/21/2019 02:00 AM
INTEROP 2019 – LAS VEGAS – Endpoint security is a common concern among organizations, but security teams should be thinking more broadly about protecting data wherever it resides.
"If you're just focusing on device protection and not data protection, you're missing a lot," said Shawn Anderson, executive security advisor for Microsoft's Cybersecurity Solutions Group, at the Interop conference held this week in Las Vegas. Rather than add multiple endpoint security products to corporate machines, he urged his audience of IT and security pros to think about protecting their data.
An estimated 60% percent of data is leaked electronically, Anderson said, and 40% is leaked physically. When an organization is breached, the incident costs an average of $240 per record. The average cost of a data breach was $4 million in 2017, a year when hackers stole more than 6 billion records.
As more devices jump online, the risk to businesses and their information continues to grow. An estimated 9 billion devices equipped with microcontrollers are deployed in appliance, equipment, and toys each year. Fewer than one percent are now connected. But that number will grow, and "highly secured" IoT devices require properties many devices don't have: certificate-based authentication, automatic security updates, hardware root of trust, a computing base protected from bugs in other code.
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May 21, 2019 / 7:18 AM / 2 days ago

Until broadband access improves, telemedicine won't help rural communities

 (Reuters Health) - Telemedicine has been touted as a solution to the dearth of doctors in rural America. But the same places where residents must drive many miles to see a physician often also have limited broadband access, a new study suggests.
About 25 percent of Americans live in rural communities while a mere 10 percent of physicians practice there, said the study’s lead author, Coleman Drake, an assistant professor in the department of health policy and management at the University of Pittsburgh Graduate School of Public Health. And making matters worse, people who live out in the country tend to be older and sicker than their urban counterparts.
“Over the last decade especially, there has been considerable interest in the potential for telehealth to make it easier to access healthcare,” Drake said. “We wondered if telemedicine really could help bridge the gap in access to care. And we discovered that in a lot of rural areas, the lack of access to broadband is potentially limiting access to telehealth.”
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Four Projects Aim to Shape Future of Family Medicine

May 17, 2019 03:27 pm News Staff – If you were at the Family Medicine Experience in New Orleans last year, you know how satisfying it is to watch a family physician take a baseball bat to an EHR system.
But in reality, FPs need more effective remedies, so the AAFP Board has dipped into reserve funds to take on the highest-priority issues facing family medicine and AAFP members today. After a series of discovery sessions, Board meetings, and requests for vendor proposals, the Board approved a one-time investment in four special projects meant to play a significant and meaningful role in advancing family medicine.
An EHR-related project, called the Tech Innovation Project, is one of them. The other three are the Consumer Public Relations Project, the Advocacy Engagement Initiative and the Website Modernization Initiative.
Expect to hear much more about these projects and the changes they are helping drive for family medicine as they evolve and deliver results. And now that this work is underway, take time here to read about the high-level strategies behind each project.
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Poorly designed systems make doctors 'a slave to their EHR'

Problems with clunky electronic health record workflows – and the inability to share patient information between clinics – are driving some physicians right out of healthcare. But some facilities have figured out how to make things work more smoothly.

OXBORO, Mass. -- While electronic healthcare records (EHRs) vastly improved patient information collection and sharing for some healthcare providers and payers, the technology also robs doctors of something critical: the ability to properly care for patients.
EHRs continue to require far too many mouse clicks and pagination to enter data during a visit, diverting attention from patients – something that's key to not only creating a relationship but getting a complete picture of their health.
"Right now, it feels like physicians are a slave to their EHRs. There's a high amount of burnout – emotional burnout, depersonalization and a low sense of professional accomplishment," Dr. Alain Chaoui, president of the Massachusetts Medical Society, said during a presentation last week at the New England HIMSS Annual Spring Conference here.
Between 50% and 70% of physicians are experiencing burnout symptoms due to EMR-related workloads, Chaoui said.
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Johns Hopkins researchers call for digital health scorecard

Published May 22 2019, 12:43am EDT
With the rapid growth of digital health solutions, there is a serious need for an objective, transparent and standards-based framework to evaluate these healthcare products.
That’s the contention of researchers from the Johns Hopkins University schools of medicine, public health and applied physics laboratory, who have developed what they contend is such a framework.
“There are more than 3 million mobile health apps out there, with 200 new ones springing up daily,” says Simon Mathews, MD, who led the research team and leads clinical innovation efforts at the Johns Hopkins Armstrong Institute for Patient Safety and Quality. “Patients, providers, payers, industry and regulators all have to navigate the confusion. It’s a challenge to find solutions that provide real value.”
In particular, the Johns Hopkins researchers contend that in the rush to get their digital health products to market many developers pay too little attention to product design, safety testing and clinical—with minimal verification and validation. As a result, no reliable mechanism currently exists to identify validated digital health solutions, they argue.
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Patients’ ability to access medical records levels off, ONC contends

Published May 22 2019, 5:38pm EDT
Patients have more ways to access their medical records, but the percentage of those offered access to their health information has remained static.
The percentage of individuals offered access to their medical record—about 50 percent—did not change between 2017 and 2018, according to a new report from the Office of the National Coordinator for Health Information Technology that examines patients’ access to view and use their online medical records.
Access to information is essential for individuals who want to better manage their healthcare needs, and share information with providers and other caregivers, ONC notes. Further, many hospitals and physician practices can help patients get and use their information, yet more work is needed to make the records more accessible and useful.
Many patients increasingly say that access to their health records is important.
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Top achieving hospitals share secrets to EHR success

Even five years after go-live, many health systems aren't realizing the full value of their electronic health records, says a new Chartis Group report. Gaining clinical and financial ROI depends on a "sustained, organized approach."
May 22, 2019 03:29 PM
Why aren't more hospitals realizing the benefits of their electronic health records? And what are the organizations that are capitalizing on their EHRs doing well that others should try?
Those are questions asked and answered in a new report from the Chartis Group, which surveyed some leading health systems that are leveraging their IT systems to enable big improvements in length of stay, reductions of adverse drug events, boosts in nursing efficiency, fewer unnecessary lab tests, speedier cash collections, better preventative care and more.
WHY IT MATTERS
The report, by Douglas Thompson and Tonya Edwards, MD, shows that even five years after attaining Stage 4 on the HIMSS EMR Adoption Model, where the benefits of improved clinical decision support should begin to show up system-wide, most hospitals still haven't fully realized them.
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The Basics of CI/CD for Data Science and Machine Learning

Continuous integration and continuous deployment are IT practices that encourage testing code often. Learn how these practices also shape data-driven initiatives.
5/17/2019
08:00 AM
Pierre DeBois
Commentary
The basics behind how machine learning and data science should work often feel less than basic. Machine learning practitioners from programmers to scientists are learning how to apply advanced statistics and mathematical application within the context of software programming. The result is complexity in selecting good machine learning models that conflict with management’s options at hand, be it objectives deadlines or limited resources to execute a decision based on the model.
Fortunately a few developer practices -- continuous integration and continuous deployment (CI/CD) -- are providing managers with ways to lead machine learning and data science initiatives early in a development process, making truly beneficial model-based decisions possible.
Let’s look at the definition of CI/CD to understand how the paired processes impact machine learning.
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Facebook releases disease prevention maps to fight flu, malaria outbreaks

Andrea Park – 20 May, 2019
Using a combination of artificial intelligence, satellite imagery and publicly available census information, Facebook has created three types of maps to improve responses to disease outbreaks, available for use by health organizations around the world beginning May 20.
The movement, population density and network coverage maps are all high-resolution depictions of communities' access to health resources. The trio of maps can be used, respectively, to predict where outbreaks of diseases like malaria, cholera and the flu will arise next, help organizations decide where to allocate resources and determine whether these intended beneficiaries can be reached with telehealth and other digital solutions.
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ONC: Physicians are still struggling with interoperability

Published May 21 2019, 12:37am EDT
While doctors’ rates of querying or finding patient health information from outside sources has increased by about half, they have not made progress in sending and receiving data electronically.
That’s the finding of the Office of the National Coordinator for Health IT based on nationally representative surveys of office-based doctors conducted in 2015 and 2017.
The good news is that physicians’ rates of electronically finding or querying data from outside sources increased by 50 percent between those years, according to ONC. However, the agency also reported that the rates of engaging in other domains of interoperability did not change during this period.
“Physicians’ engagement in electronically sending, receiving and integrating information received from outside sources did not change between 2015 and 2017,” states ONC’s data brief. “In both 2015 and 2017, about only one in 10 physicians engaged in all four domains of interoperability.”
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More than a million people missed meningitis jabs after GP software alert was left switched off

Provider EMIS has now activated the automated system under instruction from NHS Digital.
May 21, 2019 07:10 AM
More than a million people who should have received meningitis vaccines were not informed after the automated alert system for GPs failed to be switched on.  
Software provider EMIS, which is used by most GP practices in the UK, told the charity Meningitis Research Foundation that it left the alert for the Men ACWY vaccine on its default "off" setting in order to prevent "alert fatigue."
The vaccine was introduced for teenagers and young people in August 2015 to stop a rapid rise in the deadly meningococcal strain of meningitis (MenW).
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WHO rolls out free health product directory

The resource can be used to guide the development of health products, WHO says.
May 21, 2019 09:32 AM
The World Health Organization announced the launch of the Health Product Profile Directory, a resource to help promote research and development for products to combat neglected diseases and threats to global health.
WHY IT MATTERS
This includes antimicrobial resistance and diseases with pandemic potential, and the resource will also serve to guide the development of health products for which there are limited markets or incentives for research and development.
The free-to-use online resource, created and developed by TDR, the Special Programme for Research and Training in Tropical Diseases, provides a searchable database of profiles for health products needed to tackle pressing health issues in global health including those prioritized by WHO.
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CHIME urges CMS, ONC to give providers 3 years to comply with interoperability rules

May 20, 2019 1:02pm
The College of Healthcare Information Management Executives, representing healthcare CIOs, is urging federal healthcare policy officials to go slow with dual interoperability and information blocking rules by first publishing interim final rules rather than final rules.
And once those rules are published, CHIME wants healthcare providers to have three years to implement them.
In 44 pages of comments to the Office of the National Coordinator for Health IT (ONC) and Centers for Medicare and Medicaid Services (CMS), CHIME said it “strongly supports the overall intent of the CMS and ONC rules” but wants to ensure providers have adequate development time and the capacity to utilize the data received.
ONC unveiled its information blocking rule (PDF) back in February. The proposed rule, mandated by the 21st Century Cures Act, was intended to boost interoperability by defining exceptions to data blocking and fines that may be associated with the practice.
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90% of HIEs prioritize value-based care trends when adopting new tech, survey finds

Jackie Drees - Print  | Email
Trends in value-based care influence technology adoption among 92 percent of health information exchanges, according to a recent eHealth Initiative and Foundation survey.
For its 2019 Survey on HIE Technology Priorities, which was supported by population management company Orion Health, the eHealth Initiative and Foundation collected responses from 53 U.S. HIEs in 35 states. Participants were surveyed on topics including technology adoption, data exchange and business drivers.
Five survey insights:
1. Fifty-eight percent of respondents said managing risk and delivery on value-based contracts is one of the leading factors driving their business.
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Social Determinants of Health Data Deemed Most Difficult to Share

A 2019 report from eHealth Initiative indicated stakeholders view social determinants of health data as the most challenging data to exchange.

May 20, 2019 - Social determinants of health data and behavioral health data are the most difficult types of information to share through health information exchanges (HIEs), according to feedback from stakeholders from a 2019 eHealth Initiative survey.
“A lack of consensus on standards for capturing and representing SDOH data creates barriers to its collection and use, as does navigating legal parameters for cross-sector information sharing,” wrote eHealth Exchange officials in the report.
Fifty-three HIE leaders across the country responded to the eHealth Initiative survey between February and April 2019. The survey included 20 multiple choice questions about health IT adoption, clinical and claims data integration, types of data included in health data exchange, HIE business drivers and priorities, and challenges associated with health IT use and data exchange.
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Penn offers free machine learning to analyze data

Published May 20 2019, 1:18am EDT
The Penn Medicine Institute for Biomedical Informatics has launched a free, open-source automated artificial intelligence tool for both laymen and experts to conduct data analysis.
“The problem with machine learning tools is that machine learning people build them, so they’re usually only usable by those with high levels of training,” says Jason Moore, director of the Institute for Biomedical Informatics.
According to Moore, his team “has taken three years to develop this system so that it can be approachable by anyone, regardless of their training or experience,” with the goal of creating a “free and simple system that is still robust enough to transform the way we approach biomedical research—which I think we’ve accomplished.”
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HIT Think Five trends shaping the future of the radiology IT market

Published May 20 2019, 5:47pm EDT
Against the backdrop of artificial intelligence in medical imaging and other hyped healthcare IT technologies, market trends in core radiology IT software and services can easily be overlooked. Many of the largest markets in North America and Western Europe have reached saturation, with few new “greenfield” opportunities.
Instead, the dynamics of much of the global radiology IT market revolve around long procurement cycles, replacement or contract roll-on and an entrenched customer base.
However, with anticipated spending on radiology IT expected to exceed $2.5 billion, compared with more than $25 billion spent on medical imaging modality hardware, the future direction of the global market should not be overlooked.
Enterprise imaging adoption for radiology to continue
Despite the global market for radiology IT gradually declining over the next five years in terms of total revenue, a seismic shift in terms of deployment is occurring. Enterprise imaging, in which a central software platform is deployed across a healthcare network to ingest, manage, archive and allow access to all clinical and diagnostic imaging, is gaining traction.
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Robots Take a Turn Leading Autism Therapy in Schools

Autism Tech Tools Go Beyond School

New tech teaching emotional and communication skills shows early signs of connecting with children with autism spectrum disorder

By  Sumathi Reddy
May 20, 2019 5:30 a.m. ET
Two third grade students sit slumped in an office at Robert Waters Elementary School, a 2-foot robot named Milo on the table before them.
Milo moves his hands and eyebrows, blinks and makes eye contact during a session that is used as part of their autism therapy.
“Today we’re going to talk more about conversations between two people,” says Milo in a computer-generated boy’s voice that’s 20% slower than normal. “A person in a conversation may ask the other person a question and then listen for their answer and then say something else.”
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JPMorgan Chase to Acquire InstaMed to Extend Capabilities in Healthcare Payments

May 17, 2019
JPMorgan Chase & Co. (NYSE: JPM) today announced its plan to acquire InstaMed, a leading U.S. healthcare technology company that specializes in healthcare payments. The acquisition will expand the bank’s suite of payment services designed specifically for healthcare consumers, providers, and payers. InstaMed’s secure, centralized platform alleviates a number of challenges in the healthcare payments industry, with particular focus on eliminating paper, improving the consumer financial experience, and reducing costs to collect payments.
“We’ve made significant investments in our Wholesale Payments business over the years and this acquisition will give us a unique advantage in one of the fastest growing sectors. With InstaMed, we combine the strength and scale of JPMorgan Chase’s payments capabilities with a leading healthcare payments solution for consumers, providers and payers,” said Takis Georgakopoulos, Global Head of Wholesale Payments, JPMorgan Chase. “The InstaMed team is passionate about delivering an excellent client experience with a focus on innovation, keeping data safe and secure, and simplifying the end-to-end healthcare payments process – a natural fit with our Wholesale Payments franchise.”
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Payers Demanding More From HIEs

May 17, 2019
A new study has found that while providers using HIEs are focused on interoperability, payers are demanding better access to clinical data.
The survey, which was conducted by the eHealth Initiative Foundation (eHI) and backed by population health tech vendor Orion Health, collected responses from 53 U.S.-based HIEs in 35 states. The group of HIEs included some that were backed by their home state, some that were privately funded/proprietary and some that were built on a hybrid model.
The top business drivers identified by the HIEs included the desire of stakeholders to deliver on value-based care contacts (58%), easier integration using APIs, FHIR etc. (47%), providing clear value to end users such as care transition management and medication reconciliation (34%) and an increased demand for population health analytics tools (32%).
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Enjoy!
David.

Friday, May 31, 2019

The Coroner Gives The WA Government A Serve On Delays In Implementation Of Prescription Monitoring.

This appeared last week:

Coroner questions chief pharmacist’s real-time monitoring optimism

He says former soldier would not have sourced drugs if a system was in place
22nd May 2019
A coroner has expressed frustration at ongoing delays in the provision of real-time monitoring and suggested that a young former soldier might not have died if WA had such a system.
During an inquest into the oxycodone toxicity death of the 24-year-old Afghanistan veteran, Coroner Barry King also scoffed at a suggestion by the state’s chief pharmacist that the state would soon have a system.
The inquest heard that the former soldier was given a “significant supply” of oxycodone after injuring his hip and ankle in Afghanistan.
After returning to Australia, he was diagnosed with PTSD and, after further treatment for his injuries, quickly developed an addiction to opioids and benzodiazepines.
He was able to obtain 27 prescriptions for oxycodone over 99 attendances with 24 doctors, sometimes producing an ADF medical report altered to remove reference to his dependence on opioids and benzodiazepines.
After being denied scripts by several GPs who became aware of his addiction, he eventually got one for oxycodone from a new GP who found he wasn’t displaying signs of intoxication or drug-seeking. He died two days later.
Mr King said the delay in implementing a state-based real-time monitoring system was “frustrating”.
He was not convinced by Chief Pharmacist Neil Keen’s evidence that he was hopeful a database would be operational by October 2019, with pharmacists and GPs able to use it on their computers in about two years.
Mr King noted the chief pharmacist had “thought the same thing” about seven years ago.
“Mr Keen’s evidence ... does not inspire a lot of confidence that a real-time system will be functioning this year.”
More here:
It seems Mr Keen is not a man of speedy action! Really hopeless I believe.
David.