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."

Monday, January 06, 2020

Weekly Australian Health IT Links – 6th January, 2020.

Here are a few I have come across the last week or so. Note: Each link is followed by a title and a 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.

General Comment

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We are in full ‘silly season’ and there is very little news to report for the week. What I have found follows. Enjoy!
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Labor criticises Government decision to launch health website without promised feature

By political reporter Stephanie Dalzell
December 30, 2019
A Government website set up in response to concerns about out-of-pocket health costs has gone live without key promised features, like the ability for patients to search and compare specialist fees.

Key points:

  • The Morrison Government promised the website would list fees of individual specialists but the site launched today without that function
  • Labor says the site is not good enough and represents a broken promise from the Government
  • But Health Minister Greg Hunt says the website will be expanded to include the feature next year
The site can be used to search predicted out-of-pocket costs for in-hospital treatments delivered in the private sector.
Ahead of the election, the Morrison Government pledged to create the site, saying it would list the fees of individual specialists to help avoid so-called "bill shock" and crack down on doctors who charged exorbitant fees.
At the time, there were concerns some specialists were price-gouging, with reports of patients resorting to GoFundMe campaigns to raise tens of thousands of dollars for medical procedures.
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December 30, 2019 8:26 am AEDT

New website to improve consumer understanding of medical costs

The Morrison Government has taken action to reduce the effects of ‘bill shock’ from unexpected out-of-pocket medical expenses.
A new Medical Costs Transparency website will – for the first time – show Australian patients typical out-of-pocket costs for common treatments and procedures in the private system.
Australian patients will be able to search and compare predicted out-of-pocket costs for specific in-hospital treatments delivered in the private setting.
Minister for Health, Greg Hunt, said the Medical Costs Transparency website was a recommendation of the Advisory Committee, chaired by the Chief Medical Officer for the Government, Professor Brendan Murphy.
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Medical Costs Finder a disappointing first step

MEDIA RELEASE MONDAY DECEMBER 30
The Medical Costs Finder website launched today is a disappointing first step towards the greater fees transparency so sadly lacking in Australia’s private medical arrangements, the Consumers Health Forum says.
“But it is a start and we hope just the first step towards a system in which all doctors’ fees are published,” the CEO of the Consumers Health Forum, Leanne Wells, said.
“The Medical Costs Finder website is an inadequate response to the need for an open and comprehensive presentation of individual doctor’s fees and likely out of pocket costs.
“The Federal Government is promising more detailed information later and we will continue to press for more specific details to guide patients in their choices. 
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Doctors' fee transparency website goes live but fails to list who charges what

By Kate Aubusson
December 30, 2019 — 4.39pm
The federal government has launched its long-anticipated - and contested - specialist fee transparency website.
It's a promising debut, say patient advocates and public health experts, but the $7.2 million "Medical Costs Finder" has been criticised for not naming the specialists nor listing their fees.
The website, sent live on Monday, allows patients to search for the typical out-of-pocket costs of 62 common in-hospital procedures and treatments for private patients in their area and between states and territories.
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HIT-related developments in APAC – A 2019 Overview

A broad look of HIT-related developments in the APAC region in 2019, as well as a glimpse of what might happen in 2020.
January 01, 2020 09:34 PM
National level developments
Malaysia Health Minister Datuk Seri Dr Dzulkefly Ahmad has said back in November 2018 that “the Ministry of Health is committed to ensuring that the electronic medical record system (EMR) can be realised within three years at 145 hospitals nationwide.” He estimated that it would cost up to RM1.5B to implement an EMR system for the 145 hospitals nationwide in Malaysia over the next five years, HealthcareIT News reported in July 2019. While there has been quite a lot of buzz about the nation-wide EMR implementation in the country, there seems to be a lack of concrete developments in the discussion and execution of the said EMR system, something that we hope to see more of in 2020.
Vietnam, on the other hand, has gone ahead and deployed their nationwide EHR in July last year, with 24 provinces implementing EHRs. Australia’s My Health Record (MHR) has a participation rate of 90% and the Australian Digital Health Agency (ADHA), which is in charge of MHR, has been working with software vendors to improve the functionality of the MHR.
At the HIMSS AsiaPac19 conference in October 2019, the HIMSS Thailand National Digital Healthcare Workforce Development Initiative (WDI) was officially launched. This Initiative sees the development of a three-year work plan to address the demand of patients for digital healthcare services in light of the Thailand 4.0 digitization journey, as well as healthcare tourism being one of the key economy drivers. 
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Cabinet papers reveal Howard government's Y2K contingency plan

It turned out to be a non-event as the Australian government was well-prepared for it.

By Aimee Chanthadavong | January 3, 2020 -- 02:51 GMT (13:51 AEDT) | Topic: Security
The release of the 1998-99 cabinet papers by the National Archives of Australia has revealed that in 1999 the Howard government was deep into developing a contingency plan in fear of what the Year 2000 (Y2K) bug, which ended up not being bad as predicted, would do to computer systems worldwide when the date ticked over from 31 December 1999 to 1 January 2000.
In a submission made to cabinet in March 1999, then Foreign Affairs Minister Alexander Downer and Trade Minister Tim Fischer warned of how Y2K was going to have global disruptions in "banking, finance, transportation, communications, manufacturing, energy, water and sewerage, health facilities, emergency supplies, and food supply".
Downer and Fisher highlighted that Y2K would lead to "internal unrest in the event of prolonged breakdowns in critical infrastructure, including food distribution and supplies, electricity, water and gas networks, and financial services".
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Google AI system beats doctors in detection tests for breast cancer

Hannah Kuchler
Jan 2, 2020 — 3.19pm
New York | Google Health has developed a system that can identify breast cancer more accurately than radiologists, in the latest sign that artificial intelligence could improve early detection of disease in images.
In a paper published in the scientific journal Nature, experts from Google Health, Alphabet’s DeepMind unit, and UK and US universities showed the AI model reduced both false positives, in which patients are wrongly told they have cancer, as well as false negatives, where the disease is present but not diagnosed.
Screening mammograms is known to be imperfect, failing to detect about one in five breast cancers, according to the American Cancer Society. More than half of all women are given a false positive every 10 years, causing anxiety and leading to unnecessary treatment, which was estimated in a 2015 study in the journal Health Affairs to cost the US more than $US4 billion ($5.7 billion) a year.
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Australian internet users get better at skirting website blocks

By Ry Crozier on Dec 28, 2019 12:27AM

But over half of users still give up when they reach a blocked site.

Australian internet users have become much more adept at circumventing blocked websites over the past year, new numbers released by the government show.
The numbers are contained in the fifth survey of online copyright infringement trends commissioned by the Department of Communications.
This year’s survey results are slightly more aged than usual, having been conducted back in March 2019, but with results released December 27 instead of in the middle of the year.
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HCF calls for independent regulator of medical devices

Health insurer HCF has raised concerns that some doctors may be deciding what device to implant­ in patients based on commerci­al factors rather than clinical evidence.
HCF chief executive Sheena Jack has called for the creation of an independent regulator of ­medical devices that could compare­ the clinical efficacy of different brands of prostheses to combat the problem.
The independent regulator could make recommendations about which should be publicly funded.
Ms Jack said she was concerned that sales representatives from medical device companies were often present in theatres alongside surgeons, giving instructions­ on implantation of the ­prosthesis.
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Vodafone finally cuts deal to build 5G network

Dec 30, 2019 — 10.43am
Vodafone Hutchison Australia has finally reached a deal with equipment vendor Nokia to build Australia's third 5G network, months after competitors Telstra and Optus went live with their own fifth generation networks.
Vodafone said the rollout of the network would begin in the first half of 2020.
The announcement comes weeks before the Federal Court is due to hand down its decision on whether Vodafone should be allowed to merge with TPG Telecom. The $15 billion merger was blocked by the Australian Competition and Consumer Commission in May on the grounds it would lessen competition in the mobile market.
TPG had been in the process of building a mobile network, but abandoned construction in January.
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Vodafone and Nokia to be partners for 5G rollout

Vodafone has announced it will team up with Nokia for the rollout of its national 5G network.
The partnership, set to last at least five years from the first half of 2020, will deliver the telco’s first 5G coverage to sites in and around Sydney’s Parramatta in the coming months.
Nokia, which will be the network vendor, has already built a test network in western Sydney to demonstrate its 5G technology.
Vodafone CEO Iñaki Berroeta said the rollout is an “exciting milestone” for the company and would be a “seamless transition” to reach its 5G objectives sooner.
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Vodafone Australia to deploy a Nokia-based 5G network

By Ry Crozier on Dec 30, 2019 10:16AM

Overcomes Huawei equipment ban.

Vodafone Australia will launch 5G services “in the first half of 2020” on a network comprising end-to-end Nokia equipment, meaning it has found a workaround to the government’s ban on using Huawei gear.
CEO Iñaki Berroeta said the telco had struck a minimum five-year deal with Nokia that “enables Vodafone to place orders with Nokia for site delivery, thus allowing Vodafone to scale up or down the pace of its 5G rollout according to its requirements.”
Berroeta said the Nokia partnership “was the final step in a long process following the federal government’s security guidance in August 2018.”
That guidance saw Huawei and ZTE banned from Australian 5G networks, a move Vodafone warned would change the economics of 5G builds.
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Enjoy!
David.

Sunday, January 05, 2020

The #myHealthRecord May Not Be Much Use When You Really Need It!

The last few weeks have been pretty sobering in Australia due to the combination of bushfire and drought.

The number of lives lost and property destroyed has been truly awful but additionally, in a number of areas, we have seen a quite devastating loss of communications infrastructure with mobile and fixed line services out and internet access lost.

It was only while this was being reported and we were hearing about the 3-4000 people who were trapped at Mallacoota in East Gippsland did I realise just how totally useless the #myHR would be in such an emergency.

Without internet access and remembering your complex username a password your data might as well be stored in Outer Mongolia!

And when you think about it any similarly large scale natural (or man-made disaster) could cause similar infrastructure failure and a similar outcome.

A small card in your purse / wallet with the relevant info is likely to be a much better bet when it really counts.

It seems the ADHA has designed the #myHR for just mini-issues not when there is truly severe disruption! These fires serve to remind us that simple is best when your basic information needs to be available - paper betters fancy technology!

What do you think?

David.

AusHealthIT Poll Number 508 – Results – 5th January, 2020.

Here are the results of the poll.

What Are You Expecting Overall In 2020 For Australians?

A Better Year 8% (6)

Much The Same As 2019 63% (46)

A Worse Year 27% (20)

I Have No Idea 1% (1)

Total votes: 73

Well that was clear in the sense that it is obvious we are not seeing overall optimism for the New Year and a majority were pessimistic vs optimistic (27% to 8%)

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

A very reasonable turn out of votes given the Holiday season.

It must have been a very easy question as 1/73 readers were not sure how to respond.

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

David.

Saturday, January 04, 2020

Weekly Overseas Health IT Links – 4th January, 2020.

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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Digital Health’s Review of 2019 Part One: January to June

It’s been a roller coaster of a year in the NHS technology sphere, and we daresay elsewhere as well. We’ve had the creation of NHSX, lost several high-profile technology leaders to the private sector and, of course, everyone’s favourite event Digital Health Rewired 2019.
Andrea Downey – 27 December, 2019
Just when you thought all the major news was done for the year and all that was left to do was eat mince pies, Santa has on more present up his sleeve for you – it’s the Digital Health News yearly round-up.
Let’s take a sleigh ride back through some of our biggest stories for 2019…
HIT Think

4 emerging CDI trends and how they will impact the industry in 2020

December 27, 2019, 2:17 p.m. EST
The Clinical Documentation Improvement industry has been transformed by new technologies since its inception in the mid 2000s.
Today, CDI nurses act like air-traffic controllers with sophisticated software systems at their fingertips, quickly scanning, identifying and resolving opportunities for clinical documentation improvement within thousands of patient charts. The days of walking the floors with a stack of paper sticky-notes and chocolate bars are pretty much gone.
With new technologies available, hospitals are expanding CDI coverage, as they struggle to accurately and consistently translate care provided into diagnostic coding terms necessary for proper payment and publicly reported quality outcomes. Hospitals lose significant reimbursement dollars when physician documentation is not consistency and quickly clarified for coding purposes.
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AHA voices concerns about FDA guidance on clinical decision support

December 26, 2019, 10:04 p.m. EST
The American Hospital Association is concerned that if the Food and Drug Administration’s draft guidance on clinical decision support software is implemented it could hinder innovation.
According to the FDA, its draft guidance—released in September for public comment—is a proposed approach for regulating CDS software that not only fulfills the provisions of the 21st Century Cures Act, but also strikes the right balance between ensuring patient safety and promoting innovation.
However, in a letter last week to the FDA, the AHA charged that the regulatory agency’s “interpretation of certain criteria could result in many existing CDS algorithms being subject to the FDA approval process and ultimately slow the pace of innovation and development of new software tools to support better patient care and outcomes.”
In particular, AHA notes that the FDA proposes to focus its regulatory oversight on CDS functions that are intended to help a healthcare professional inform their clinical management for serious or critical conditions and that are not intended for professionals to independently evaluate the basis of the software’s recommendations.
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The economy of connecting

The monetisation of patient data is set to be one of the biggest drivers of new business models across the healthcare landscape – and ownership of that data can give patients the power to shape the kind of healthcare they want.
December 27, 2019 05:00 AM
Right now, patients don’t know their own strength. But as they wake up to their emerging role as keepers of their own healthcare data, the economic clout that comes with ownership will hand them a controlling stake in the new business models that are set to disrupt traditional financing across the sector.
Forecasts give a strong indication of the potential scale of that role – and the reasons why technology startups, insurers, providers and researchers are gearing up for the age of value-based health, in which patients will trade their data as currency, investing in their own care outcomes and the tools that will help to identify and realise them. 
An IDC/Seagate whitepaper, The Digitisation of the World, for example, estimates a CAGR of 36% for healthcare data by 2025, making it the fastest growing sector by some distance. Put this in the context of a global data monetisation market worth almost $708bn by the same year, and the economic impact of patient data ownership becomes clear.
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Mayo Clinic names first chief digital officer

Rita Khan, who comes to the health system from UnitedHealthcare, will guide digital strategy and spearhead the launch of Mayo's new Center for Digital Health.
December 27, 2019
Mayo Clinic announced this week that it has created the role of chief digital officer, and hired Rita Khan, who most recently served as senior vice president of consumer digital at UnitedHealthcare, to the new C-level position.
WHY IT MATTERS
In her new role, Khan will guide Mayo Clinic's strategy as it prepares for big changes across the digital space, according to the health system.
As CDO, Khan will chart digital strategy, putting in place a "comprehensive business plan and digital standards that align with Mayo Clinic's culture and values," and establish the new Mayo Clinic Center for Digital Health.
At UnitedHealthcare, Khan directed enterprise-level digital strategy and lead a team that designed new digital tools for providers, employers and members across the insurer's commercial, Medicare and Medicaid businesses.
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Emory Healthcare, Verily partner to improve medication, lab ordering

The Atlanta health system will work with the Alphabet subsidiary on several new initiatives, starting with deep analysis of existing medication and lab ordering patterns at Emory.
December 27, 2019 11:19 AM
Georgia’s largest health care system, Emory Healthcare, announced a partnership with Verily, a subsidiary of Alphabet, Google’s parent company, which is focused on life sciences and healthcare.
The aim of the partnership, built on Emory’s capabilities as an academic medical center and Verily’s expertise in data science, analytics, user experience and product development, is to develop and deploy a host of solutions to help improve cost-effectiveness, operational efficiency and quality of healthcare.
One of the first areas of organizational change the two partners will focus on is a deep analysis of existing medication and lab ordering patterns at Emory, which will in turn be followed by solutions to improve the processes involved in those areas
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Third-Party Vendor Risk Management in Healthcare

December 27, 2019
One of the realities I’ve seen is that the healthcare CIO is largely a vendor manager. I’ve grown that view a bit to include the management of people, but that’s the majority of a CIO’s job. Manage the people that work for the CIO and manage the vendors that work with their organization.
This is not a knock on CIOs. This is really important work that they’re doing. Although, it is a recognition that much of the risk they take on as CIO is dependent on the vendors with whom they work. This is true from an innovation perspective where the innovations of the vendor will either make the CIO look really good or really bad. However, it’s also true from a multitude of other financial, legal, security, and reputation standpoint as well.
How then are CIOs managing their third-part vendor risk?
I’m sad to say that the reality for most organizations is simply: a bunch of spreadsheets.
Chew on that for a minute. A CIO’s third-party risk is being managed by a bunch of spreadsheets. I love a spreadsheet as much as the next person, but we know that a file on Sharepoint is the place where documents largely go to die. Plus, managing hundreds of spreadsheets across a wide variety of vendors is brutal.
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Clinical Trial Finds Google Glass App Helped (Slightly) Improve Socialization of Autistic Children

December 27, 2019
While it continues to be an intriguing technology, Google Glass is not in wide use in healthcare today, though It’s far from dead,
Also, there’s still those who are exploring ways in which it might help patients, including the following study which seems to have generated some positive results. (There’s reason to be skeptical about these conclusions, however. More on this below.)
According to a recent paper published in JAMA Pediatrics, a group of researchers set out to find out whether Google Glass (which it describes as “a wearable artificial intelligence intervention designed for use in the home” ) would reinforce facial engagement and emotional recognition among children with autism spectrum disorder and thereby improve their social skills.
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Algorithms, MRI scans help predict 10-year breast cancer recurrence

December 25, 2019, 11:11 p.m. EST
Researchers at Penn Medicine have used radiomics, a method that leverages algorithms to extract large amounts of features from medical images, to provide more personalized tumor characterization for breast cancer patients.
In the process, the algorithms were able to successfully predict recurrence-free survival after 10 years, according to a study published in the journal Clinical Cancer Research.
Researchers contend that the use of imaging to characterize the genetic makeup of tumors can pave the way for individualized, non-invasive treatment.
“Our study shows that imaging has the potential to capture the whole tumor’s behavior without doing a procedure that is invasive or limited by sampling error,” says Rhea Chitalia, lead author of the study and a doctoral candidate in the School of Engineering and Applied Science at the University of Pennsylvania. “Women who had more heterogeneous tumors tended to have a greater risk of tumor recurrence.”
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Technologists upbeat about AI impact on their careers, but not on society

December 26, 2019, 3:30 a.m. EST
Artificial intelligence will shape the technology landscape of the 2020s, but unintended consequences pose big risks, according to a new report from ISACA, a technology professional association.
The evolving relationship between AI, automation and humans is expected to create promising opportunities in the technology workforce, while simultaneously presenting sobering concerns for the general public, the study said.
For its research, ISACA surveyed more than 5,000 business technology professionals, and found that respondents are significantly more optimistic about how technology advancements in the new decade will impact their career than they are about how it will impact society as a whole.
Some 59 percent of respondents expressed optimism for the ramifications of AI on their careers, compared with only 40 percent who are similarly upbeat about the overall societal impact.
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Proposed Senate bill aims to coordinate federal SDOH efforts in Medicaid

December 26, 2019, 2:49 p.m. EST
A bill proposed in the Senate would aim to use a coordinated approach among federal agencies to address social determinants of health for Medicaid recipients.
The approach would incorporate the use of data from several federal agencies to better meet the needs of recipients whose health is influenced by a wide variety of factors, such as access to medical care and transportation, proximity to sources of nutritious food, and issues with social isolation and lack of safe housing.
The bill, S. 2986, entitled the Social Determinants Accelerator Act of 2019, was introduced by Sen. Todd Young (R-Ind) and is co-sponsored by Sen. Debbie Stabenow (D-Mich.). The bill has been referred to the Senate Finance Committee. The bill asks $20 million to fund the program for five years.
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ADA says autonomous AI meets diabetes standards of care

The news is being touted by IDx, makers of the first medical device approved by FDA to use artificial intelligence to assess diabetic retinopathy.
December 26, 2019 03:26 PM
In a move that could help win over some skeptics about the value and efficacy of AI in clinical care, The American Diabetes Association, in its new set of clinical standards, recognizes the use of autonomous artificial intelligence for the screening of some medical conditions.
WHY IT MATTERS
The ADA's new 2020 Standards of Medical Care in Diabetes includes language noting that “AI systems that detect more than mild diabetic retinopathy and diabetic macular edema authorized for use by the FDA represent an alternative to traditional screening approaches.”
The clinical standards – published earlier this month in the peer-reviewed journal Diabetes Care – represent a new source for evidence-based best practices, consulted by hospitals and health systems, physicians, insurers and quality organizations.
While acknowledging that autonomous AI can be an alternative to traditional screening, however, the ADA specifies that it feels the "benefits and optimal utilization of this type of screening have yet to be fully determined."
In addition, it cautions that "artificial intelligence systems should not be used for patients with known retinopathy, prior retinopathy treatment, or symptoms of vision impairment."
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Health IT Leaders choose MU, Consumerism and Cloud as Top Stories of Past Decade

December 26, 2019
Over the past decade we have moved from a world where more than half of healthcare processes were paper-based to one that is mostly electronic. We also saw the rise of patient portals, a movement towards value-based care, the implementation of a new billing code system and an explosion of health data.
It’s hard to pick just one development from the past decade of Health IT as THE ONE that stands out the most, but that’s exactly what John Lynn and I tried to do on a recent episode of the Healthcare IT Today Podcast. My pick was government regulations. Nothing else had a bigger impact on healthcare in my opinion.
Things got started with the Health Information Technology for Economic and Clinical Health (HITECH) Act which begat the Meaningful Use program. That program eventually poured $28 Billion in federal stimulus money into EHRs (and Health IT in general) starting in 2011.
Later, we had the Patient Protection and Affordable Care Act (commonly referred to as Obamacare) which led to the creation of the federal health exchange – HealthCare.gov. This exchange landed with a thud. The story of HealthCare.gov became both a case study on how NOT to launch national government IT initiative and how to FIX one.
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Electronic Health Records Creating A 'New Era' Of Health Care Fraud

By Kaiser Health News  |   December 23, 2019

Major EHR software makers have allegedly gamed the system, repeatedly.

KEY TAKEAWAYS

·         Whistleblower lawsuits allege that some EHR software used in hospitals and medical offices has hidden flaws that may pose a danger to patients.
·         Three major EHR vendors have made multimillion-dollar settlement deals — totaling $357 million — over DOJ investigations.
·         Beyond those cases, federal officials have paid hundreds of millions of dollars in subsidies to doctors and hospitals that could not show they were even qualified to receive them. 
This article was first published on Monday, December 23, 2019 in Kaiser Health News.
Derek Lewis was working as an electronic health records specialist for the nation's largest hospital chain when he heard about software defects that might even "kill a patient."
The doctors at Midwest (City) Regional Medical Center in Oklahoma worried that the software failed to track some drug prescriptions or dosages properly, posing a "huge safety concern," Lewis said. Lewis cited the alleged safety hazards in a whistleblower lawsuit that he and another former employee of Community Health Systems (CHS) filed against the Tennessee-based hospital chain in 2018.
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AI software test shows promise for breast ultrasound diagnoses

December 24, 2019, 11:52 a.m. EST
A test of artificial intelligence in assessing breast ultrasound examinations has offered some evidence that it aids in cancer detection and boosts physician accuracy.
The best, conducted by a New York-based private practice radiology group that performs a high volume of such exams found promising results in assessing lesions found during breast ultrasound examinations.
The evaluation spanned 18 months and involved nine specialist radiologists who used artificial intelligence software from Koios Medical, which has been cleared for use by the Food and Drug Administration.
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Mobile apps offer suicide intervention potential, but oversight is lacking

December 24, 2019, 12:30 p.m. EST
Mobile apps may help address the needs of persons at risk of suicide, according to results of a study conducted at Nanyang Technological University in Singapore.
However, more vigilance is needed to ensure that apps that are available are effective in heading off potential life-threatening events.
In the project, researchers assessed six types of mobile apps that could help in depression management—these include mood and suicidal thought tracking; safety plan development; recommendation of activities to deter suicidal thoughts; information and education; access to support networks; and access to emergency counseling.
Worldwide, an estimated 800,000 people commit suicide, and about 16 million make a suicide attempt each year.
Timely identification of persons at risk for suicide is important to ensure adequate provision of care. Some 60 percent of individuals with suicidal ideation transitioned to a first attempt within a year of onset, which is a significant number considering that half to two-thirds of suicide deaths occur in the first attempt. More than 90 percent of persons who died by suicide had depression, alcohol abuse or both.
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ONC data shows potential link between EHRs and patient harm

December 23, 2019, 9:35 p.m. EST
Publicly available electronic health record surveillance data shows a possible link between EHRs and patient harm, according to researchers from the MedStar Health National Center for Human Factors in Healthcare.
That’s the finding of a research letter published last week in the Journal of the American Medical Association.
MedStar researchers contend that their results represent the “first-of-its-kind” examination of EHR surveillance data collected by the Office of the National Coordinator for Health IT, with all publicly available surveillance data—from Jan. 28, 2016, to June 24, 2019,—analyzed.
“This is a unique analysis,” contends Raj Ratwani, director of the MedStar Health Human Factors Center and an author of the JAMA research letter. “Nobody’s really done this kind of analysis with those data before.”
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Drugmakers Turn to Data Mining to Avoid Expensive, Lengthy Drug Trials

Pfizer, Johnson & Johnson and Amgen try to win drug approvals by analyzing vast data sets of electronic medical records

By
Peter Loftus
Updated Dec. 23, 2019 9:55 am ET
Drugmakers are trying to win drug approvals by parsing vast data sets of electronic medical records, shifting away from lengthy, and costly, clinical trials in patients.
Pfizer Inc., PFE -0.08% Johnson & Johnson JNJ -0.35% and Amgen Inc. AMGN -0.29% are among the drugmakers that have submitted the data-mining analyses to the U.S. Food and Drug Administration in seeking approval to sell new medicines or for new uses for older ones. The FDA has approved new uses for breast cancer, bladder cancer and leukemia drugs in part based on the data.
For the companies, the use of real-world data can cut costs and shorten drug-development times. Instead of finding trial subjects, companies simply mine hospital and doctor files for cases where patients already took a drug in routine medical care, looking for changes in blood pressure, tumor size and other readings to see if the medicine is helping or causing a side effect.
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Why Physicians Should Care About Wearables

Hansa Bhargava, MD, and Keith L. Martin
December 20, 2019
We are at the point of the "digital revolution" in healthcare and it is growing at a fast pace. With all of these new innovations, one issue is clear: The physician needs to be in the know, so we can continue to guide this new era.
Having a doctor at the table for all these new types of disruptive technology will help healthcare, help us be a part of the conversation, and ultimately will ensure that the patient gets optimal care.
One such example is wearable devices, creating a new form of data generated by the patient for interpretation by physicians.
The wearable medical device marketplace is expected to reach $14.1 billion by 2022 (from $6 billion in 2017). This growth is attributed to factors including new technology, greater use of smartphones, and growing preference for wireless connectivity among healthcare providers and patients. In a recent survey administered by Accenture in over 2000 patients, 75% stated that technology and digital health was somewhat or very important to them.
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Payers Are Using mHealth, Telehealth to Promote Better Health Outcomes

mHealth tools and telehealth services are giving payers like Humana the opportunity to push better data to their members and care providers - which, in turn, will help them make better decisions about health and care.

December 20, 2019 - mHealth and telehealth are enabling payers to give their members and care providers the information they need to make better decisions and provide better care.
But it’s not just about giving doctors and patients more data, says Worthe Holt, vice president of the Office of the CMO at Humana. It’s about giving them new data not found in the medical record, and in real or near-real time, helping them to make more impactful decisions about healthcare and wellness.
“Having actionable insights and data at your fingertips is extraordinarily important if you’re going to be effective,” Holt said during a recent episode of Healthcare Strategies, the Xtelligent Healthcare Media podcast series.
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Few Apps for Depression & Suicide Prevention Meet Clinical Guidelines

By Traci Pedersen
Associate News Editor
Last updated: 21 Dec 2019
Most (93 percent) mobile apps for suicide prevention and depression management do not provide all six suicide prevention strategies commonly recommended in international clinical guidelines, according to a new study led by Nanyang Technological University (NTU), Singapore.
Currently, there are more than 10,000 mental health apps available on the Apple App store and Google Play. But even as digital mental health interventions seem to offer a promising alternative to in-person visits, very few apps available in the app stores have been evaluated in clinical trials or by regulatory bodies.
The study, published online in the journal BMC Medicine, highlights the need for responsible design and creation of guidelines for apps that could have a significant impact on people’s lives.
For preventing suicide, international guidelines from the UK, US and the World Health Organization (WHO) recommend six evidence-based strategies: the tracking of mood and suicidal thoughts, development of a safety plan, recommendation of activities to deter suicidal thoughts, information and educational articles on signs of suicidality, access to support networks, and emergency counselling.
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‘Gist’ processing of images enhances AI’s breast cancer risk assessment

December 23, 2019, 2:05 p.m. EST
Machine learning—combined with radiologists’ intuitive, or “gist” processing—is more accurate in assessing breast cancer risk than either approach alone.
Deep learning models, such as convolutional neural networks (CNNs), enable automatic screening of life-threatening breast cancers at an earlier, more curable stage. However, CNNs rely on large annotated datasets for clinical diagnosis as input.
Gist is the memory representation of the bottom-line meaning of an experience. Gist-based intuition is a human visual ability, an advanced form of reasoning that is mainly unconscious and develops with experience. However, it has not been used in neural networks for screening mammograms even though it enables the human visual system to readily extract meaningful information. For instance, radiology experts can classify mammograms as normal or abnormal at above-chance levels after less than one second exposure to the image.
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Study suggests analytics, screening tools and EHRs can aid autism treatment

December 23, 2019, 2:25 p.m. EST
New research is trying to determine if computer automation coupled with clinical decision support software can increase timely screening of autism spectrum disorder.
Autism spectrum disorder (ASD) represents a range of disabilities in speech, social interaction and intellect, and features repetitive movements or behaviors ranging from mild to severe. Although the prevalence of ASD has been increasing in recent decades, primary care physicians may not have a deep understanding of autism and may not routinely screen pediatric patients for its signs.
An article in the Journal JAMA Network.com describes research involving a clinical trial that took place in four primary care practices at Eskenazi Health System in Indianapolis. The trial compared ASD screening rates among 274 children in urban pediatric clinics of an inner-city county hospital with or without a screening module built into an existing clinical decision support system.
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VA providing vets with digital tools to access healthcare info

December 22, 2019, 10:45 p.m. EST
The Department of Veterans Affairs has added a number of online resources to improve access to patient statements as well as compare the performance of VA medical facilities with non-VA facilities.
Through the agency’s AccessVA website, veterans receiving care for non-service related conditions can now view, download and print their patient statements electronically, using their secure information for DS Logon, ID.me or MyHealtheVet Premium.
While the VA will continue to mail veterans paper statements, online patient statements are available on AccessVA for as long as six months and include a summary of services received at any VA medical facility.
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HIT Think

How the technology puzzle can help address youth suicide

December 23, 2019, 2:43 p.m. EST
Perhaps it’s because we live in an age of competing epidemics and crises—opioids, impeachment, homelessness, insulin—that youth suicide trends don’t warrant a front-page headline every week.
The numbing, knee-bending statistics say they should.
Per the CDC, suicide rates among young people 10 to 24 years old rose 56 percent between 2007 and 2017. Suicide is now the second leading cause of death for that group after accidents like car crashes—paradoxical tragedies often caused by the excessive exuberance of youth. Of course, the number of suicides is a small subset of the number of attempts, which are up 400 percent.
The numbers give rise to so many questions, primary among them, “Why?”
The answer is by no means clear. Desperation is almost always a complex brew of family dynamics, economics, romantic relationships, peer pressure, sexual orientation, genetics and other factors. Despite that, academic Jean Twenge notes that the rise in youth suicide tracks with the explosion of smartphone use. According to Twenge, a San Diego State psychology professor, that’s not circumstantial.
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Hancock announces ‘digital aspirant’ programme for hospitals

The health secretary made the announcement in his first speech following last week's UK general election.
December 19, 2019 01:23 AM
After a tumultuous election, health secretary Matt Hancock returned to the post with a speech that reinforced his focus on technology and revealed plans to launch a ‘digital aspirant’ programme for hospitals in England.
WHAT HAPPENED
“If you thought I was going to relent on tech then I’m afraid I’ve got some bad news for you,” Hancock said today at the Policy Exchange think tank in London.
“Until now, the focus has been on getting some hospitals up to scratch through the global digital exemplar [GDE] programme,” he continued. “They’ve [GDEs] got to keep advancing, but now we’re going to help many more hospitals with a new digital aspirant programme.”
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Patient-centricity taken seriously

Everybody talks about putting the patient in the driving seat. But connected care platforms that take this vision seriously continue to experience a hard time. How should patient-centricity be reimbursed?
December 23, 2019 05:20 AM
By most standards, severe hemophilia is an infrequent disease. It is estimated that around 20,000 people suffer from it in the US. In Europe, a little more than 1 in 10,000 newborns carry a hemophilia A or B mutation. Those of them who need treatment are taken care of in around 420 specialised centers all over the continent. Hemophilia is not only rare, it is also pretty expensive. To prevent bleedings, for example into the joints, patients inject clotting factors or antibodies that they store at home. Treatment costs can add up to several hundreds of thousands euros per year, strongly dependent on how much injectable therapies the individual patient actually needs.

Digital hemophilia platform optimises use of expensive clotting factors

“Given this background, there is a clear rationale for managing hemophilia patients with a digital platform. Doing so allows us to monitor compliance, and it also allows us to correlate bleeding events and medication in order to find the optimal dosing schedule for each individual patient,” says Andreas Rösch of Rösch & Associates, a Frankfurt-based company that is offering the digital haemophilia platform “smart medication”. At the moment, nearly 1,300 hemophilia patients in Germany and Switzerland, roughly one out of three, use the application for their medication management and for communicating with their doctors. Forty-five hemophilia centers in these two countries offer the solution to their patients. 
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In 2019, social determinants of health got the attention they deserve

Hospitals and health systems are beginning to embrace a more holistic approach to ensuring the wellness of their patient populations, and are adjusting their IT strategies to accommodate it.
December 23, 2019 03:16 PM
In a March 2019 interview with Healthcare IT News, Dr. Jacob Reider – CEO of the Alliance for Better Health and former deputy national coordinator for health IT – described the conversations he'd been having about social determinants of health with an array of different healthcare stakeholders.
"There's a lot of interest in this in this domain," he said. "Folks from federally-qualified health centers, so on the frontlines of the medical side. We had folks from states, and/or or former state leaders who are looking at this from a public health perspective. We had folks from social care providers. We had health plans. So we had this really broad cross section of the care continuum, all saying, 'Hey this is important and we would like to participate in some way, in figuring this out together.'"
The push to do a better job incorporating social determinant information into care and treatment plans gained momentum in 2019, as more and more provider organizations recognized the key role that housing, transportation, food security and other non-clinical factors play in patients' health.
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2020 Could Be The Year Wearables Find Their Place In Healthcare

December 23, 2019
After many years as a black sheep of the healthcare family, the wearable is coming into its own.  This has been signaled in no uncertain terms by Google, a kingmaker if there ever was one, which recently acquired wearables giant Fitbit for $2.1 billion.
As influential and cash-rich as Google is, though, I don’t think even the big G is capable of forcing a market to come together single-handedly. In fact, I see the acquisition as more of an effect of converging forces and trends, including the following:
  • Larger providers are reaching the point where they to see the value of collecting healthcare data from virtually any source they can identify.
  • The maturation of artificial intelligence technologies, especially machine learning, has added new purpose and power to providers’ data analytics projects.
  • A growing number of use cases (such as this one) are emerging, lending strong support to the idea that AI-fueled big data projects can make a major clinical and financial impact.
  • A growing number of consumers are beginning to buy into the idea that health data can be used not only stay in shape but also to improve the health in other ways,
  • Wearables are beginning to clear regulatory hurdles, with several obtaining FDA clearance or approval during 2019 including devices treating irritable bowel syndrome and ADHD and tracking vitals and heart rhythms.
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EHRs and Collaboration: Leveraging Technology to Help Patients with Substance-Use Disorders

December 23, 2019
The following is a guest article by Charlie Hutchinson, CFO at InSync Healthcare Solutions.
The growth in substance use disorders [SUD] across all demographics and income brackets has impacted the role of primary-care providers [PCPs].
Physicians, especially those in rural and/or underserved parts of the country, who are most affected by the opioid epidemic, have had to step up their engagement with patients to help them physically, mentally and emotionally. They’ve also had to increase collaboration with behavioral health providers, including SUD professionals.
In 2018, CMS unveiled a new Psychiatric Collaborative Care Model in the Physician Fee Schedule that would enable providers to generate revenue when they co-manage patients with a psychiatrist or other behavioral health professionals. And in August, the Department of Health and Human Services [HHS] proposed updates to 42 CFR Part 2 — the federal regulations governing the confidentiality of patient records created by SUD treatment programs — to improve care coordination and outcomes for patients with substance-use disorders.
These are just two of many efforts intended to foster a more collaborative relationship.
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Monday Morning Update 12/23/19

HisTalk - Top News

In Australia, government health officials admit that while 23 million people have a My Health Record online health account – most of them only because enrollment was changed from opt-in to opt-out early this year – 91% of them have never logged in and most of those who did log in have not returned.
A large percentage of public hospitals, pharmacies, and medical practices are connected, but only 33% of private hospitals and less than half of medical and diagnostic labs.
The Australian Digital Health Agency has had to pay software vendor, pathology providers, and imaging providers for integration in trying to boost data availability and usage.
The system cost more than $1 billion to develop and annual maintenance costs are estimated at $350 million.
The digital health agency’s CEO is Tim Kelsey, who just resigned to take an SVP job with HIMSS. 
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Weekly News Recap

  • The National Academy of Medicine publishes an overview and recommendations for the use of artificial intelligence in healthcare.
  • LifeLabs, Canada’s largest lab testing company, admits that it paid a hacker’s ransom to recover its systems in an October breach that affects 15 million patients.
  • Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.
  • HIMSS hires Tim Kelsey, CEO of the Australian Digital Health Agency, for an SVP of analytics job.
  • Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its systems.
  • A Florida pain management chain pays $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party.
  • Partners HealthCare announces a five-year, $100 million digital health initiative.
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Enjoy!
David.

Friday, January 03, 2020

That There Are Errors In Care Related To EHR Use Is Not A Surprise. There Are Also Errors When They Are Not Used!

This appeared last week:

Health documents reveal patient harm linked to Queensland's new medical record system

Exclusive by state political reporter Josh Bavas
24 December, 2019
Almost 100 cases of patient harm have been linked to Queensland's new electronic medical record system in just over a year, including instances of patients being administered incorrect doses of drugs.

Key points:

  • Documented cases include child given 10 times the amount of insulin they were prescribed and a patient administered morphine in milligrams, not micrograms
  • One patient in severe pain was unable to be given pain relief because of a 'computer system failure'
  • Queensland Health says the Integrated Electronic Medical Record (ieMR) is working well
On one occasion late last year, a child at Queensland Children's Hospital was mistakenly given 10 times the amount of long-acting insulin they were prescribed.

In other examples, a child at the same hospital was given incorrect morphine over the course of a day, an adult at the Mackay Hospital was mistakenly given more than double the required units of insulin and another patient at the Sunshine Coast was administered morphine in milligrams instead of micrograms.
These are just some of the 95 cases of harm linked to the new Integrated Electronic Medical Record (ieMR) system recorded by Queensland Health from January 2018 to April 2019 and obtained by ABC News after a Right to Information request.
Another incident at the Ipswich Hospital in January recorded a patient in severe pain who was unable to be given pain relief because of a "computer system failure".
Health documents state nursing staff were unwilling to administer any medication simply because the "computer system was down".
In another case, a patient was administered drugs due for another person.
The ieMR network replaces various paper-based clinical charts with one online platform and has been deployed across 16 hospitals with a further 14 to come online soon.
While the ieMR was documented to be a contributing factor in each case, Queensland Health said 45 instances were due to user error and 32 because the system was found to be "difficult to use".
Other contributing factors included poor communication, lack of training, missing documentation and inattention.
In March, the ABC revealed the Australian Medical Association secretly called on the State Government to halt the ieMR rollout over concerns about patient safety.
Lots more here:
The problem with such claims is the counter factual which we don’t have regarding error levels before the iEMR was implemented and we don’t know what errors have been eliminated and which accentuated.
Remember the iEMR makes it much easier to track errors of many types.
A decent before and after study and careful staff training are needed to know if the effect is negative or positive.
David.