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, March 30, 2020

Grahame Grieve Is Making A Really Useful Push For Australian Practices.

Republished with permission.

ClinicArrivals – helping Australian GPs with Covid-19

Posted on March 29, 2020 by Grahame Grieve

A couple of weeks ago, Nathan Pinskier reached out to me on behalf of the RACGP expressing concern about the impact of COvid-19 on Australian GPs.
Talking to Nathan, it was clear that there’s 2 acute challenges facing GPs:
  • sudden real concern about infection control and therefore keeping patients out of the waiting room
  • Rapid changes in telehealth arrangements.
As a gross generalisation, over a 2 week period, GPs have moved from being not allowed to use telehealth at all to being required to do it for a rapidly growing percentage of their population. You just can’t make changes to your system and workflow that quickly. And though there are good tele-health solutions out there, they are not integrated into the existing systems that GPs are using. As a consequence, GPs are trying to use WhatsApp or Skype, but these are a workflow disaster in this context (see, for instance, how to get your skype id).
What is needed is something that is zero impact for patients, ubiquitously available, and deeply integrated into a GPs workflow, since that’s increasing at this time. Further, it has to be available NOW, without requiring system change for every GP in the country.
The only way I could think that we could possibly solve that was if I partnered with Brett Esler from Oridashi, and we used his FHIR access library to access the GPs Practice Management System (PMS) Appointment diary, and then message using SMS the patients to find out whether a telehealth consultation was possible/appropriate, and then, if it is, set up a video session, and if it’s not, let them SMS that they are waiting from the car park, and then released that as an open source application.
I’m happy to say that as of today the ClinicArrivals application is now available for testing in limited production settings.
I didn’t do this by myself. In fact, I only did a fraction of the work. Other people contributed – in fact, dropped everything to contribute, all in their own time:
  • Brett Esler gave us free use of his FHIR GP Access library to access the appointment diary for Best Practice, Medical Director, and ZedMed and then worked to improve it for us.
  • Brian Postlethwaite wrote the actual guts of the application over a 96 hour period
  • Shovan Roy worked with me to figure out how to do the video-conferencing
  • James Berry set up the video conferencing server on AWS
  • Vadim Peretokin organised the build/release framework
  • Mel Grieve helped with the documentation for the video usage
All of those people contributed to the design, and it wouldn’t have happened with out them. Also, I need to give credit to Josh Mandel for sage early advice, Best Practice for waiving the commercial fees to be a partner so this is above board (and doing so in a timely fashion at a time of immense pressure), and most of all Nathan Pinskier for advice, encouragement, and volunteering to be the initial prototype site.
For video conferencing, we looked at a number of different approaches. Our criteria was that it be zero-install and near zero impact for the patient, not involve enrollment of the patient in anything, and not cause any delay for the GP, and have a RESTful API that we could use to orchestrate the service.
In the end, the only choices we found were two open source video conferencing solutions:
  • Jitsi – a very excellent video conferencing service that my family is now using while we’re staying at home
  • OpenVidu – another very flexible video-conferencing solution.
We chose Openvidu because it is near zero install for patients (doesn’t work on IE or Edge) and does have a simple to use RESTful API. Unfortunately, it requires a server which is not simple to install (though James is working on that). For now, then, I’m running that server as a free service while we figure out what to do about that.
There’s still plenty to be done, but the application seems to have reached MVP and so 10 days after it was conceived, we are trialing it with real patients today.
My deep thanks to everyone who helped with this process. Hopefully it will make a small difference in our grand fight against this virus.
P.S. where does this go long term? I can’t see it being a product. Actually, I’m hoping that since it’s open source, the PMS vendors will integrate the basic approach and methods into their own products, and this will naturally be superceded.
P.P.S: What this does underscore is why APIs are so important – what we wrote is just a mash-up between a bunch of RESTful APIs for the PMS, SMS, and videoconferencing. That’s why APIs matter: they create a resilient responsive eco-system that’s able to respond like this. Long term, the focus of governments should be clear: force your system to adopt APIs (that, of course, is not today’s problem)

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Great stuff!

David.

Sunday, March 29, 2020

I Think Our Modes Of Consultation With Our Health Workers Are Going To Change Forever!

This was announced earlier today, as part of the response to the COVID-19 virus.
March 29, 2020 11:08 am AEDT

$1.1 billion to support more mental health, Medicare and domestic violence services

More help will be given to millions of Australians battling the devastating impacts of coronavirus with a $1.1 billion package which boosts mental health services, domestic violence support, Medicare assistance for people at home and emergency food relief.
Prime Minister Scott Morrison said more support would be rolling out immediately to deal with the secondary effects of the health and economic crisis caused by coronavirus.
“As we battle coronavirus on both the health and economic fronts with significant support packages in place and more to come, I am very aware many Australians are understandably anxious, stressed and fearful about the impacts of coronavirus and what it brings,” Prime Minister Scott Morrison said.
“We are focused on saving lives and saving livelihoods and this new support package will provide much needed care and help to so many Australians facing hardship at no fault of their own.
“We will get through this crisis by staying together, by supporting each other and ensuring that no Australian, even though we have to be isolated, should have to go through this alone.”
Medicare support at home – whole of population telehealth
To provide continued access to essential primary health services during the coronavirus pandemic, $669 million will be provided to expand Medicare-subsidised telehealth services for all Australians, with extra incentives to GPs and other health practitioners also delivered.
Australians will be able to access support in their own home using their telephone, or video conferencing features like FaceTime to connect with GP services, mental health treatment, chronic disease management, Aboriginal and Torres Strait Islander health assessments, services to people with eating disorders, pregnancy support counselling, services to patients in aged care facilities, children with autism, after-hours consultations and nurse practitioners.
Providing the opportunity to get health services at home is a key weapon in the fight against coronavirus while limiting unnecessary exposure of patients and health professionals to the virus, wherever treatment can be safely delivered by phone or videoconferencing. This will take pressure off hospitals and emergency departments and allow people to access essential health services in their home, while supporting self-isolation and quarantine policies.
The GP bulk billing incentive will be doubled for GPs and an incentive payment will be established to ensure practices stay open to provide face to face services where they are essential for patients with conditions that can’t be treated through telehealth. The new arrangements will be in place until 30 September 2020, when they will be reviewed in light of the need to continue the fight against coronavirus.
Domestic violence support
An initial $150 million will be provided to support Australians experiencing domestic, family and sexual violence due to the fallout from coronavirus.
Google is seeing the highest magnitude of searches for domestic violence help that they have seen in the past five years with an increase of 75 per cent and some services are already reporting an increase in demand.
The funding will boost programs under the National Plan to reduce Violence against Women and their Children including:
  • Counselling support for families affected by, or at risk of experiencing, domestic and family violence including men’s behaviour change programs which will provide a short, medium and longer term response to support men.
  • 1800RESPECT, the national domestic, family and sexual violence counselling service, which already answers around 160,000 calls a year.
  • Mensline Australia, the national counselling service for men that provides support for emotional health and relationship concerns for men affected by or considering using violence.
  • Trafficked People Program to support particularly vulnerable cohorts such as victims of human trafficking, forced marriage, slavery and slavery-like practices.
  • Support programs for women and children experiencing violence to protect themselves to stay in their homes, or a home of their choice, when it is safe to do so.
A new public communication campaign will roll out to support those experiencing domestic violence over this period and to ensure those affected know where they can seek help.
Minister Payne and Minister Ruston will convene a COAG Women’s Safety Council meeting on Monday to discuss with the states and territories how to best deliver this funding to support local responses to this issue.
Mental health support
An initial $74 million will be provided to support the mental health and wellbeing of all Australians.
The Government’s digital mental health portal, Head to Health (www.headtohealth.gov.au), will be a single source of authoritative information and guidance on how to maintain good mental health during the coronavirus pandemic and in self-isolation, how to support children and loved ones, and how to access further mental health services and care.
Here is a link:
This package runs till the end of September and it seems me that this will result in millions having the opportunity of using remote consultations and many will find it useful and will be keen to not go back to the old ways for suitable contact.

For many consultations telehealth is safe, effective and works for both the clinician and patient. There are some useful comments on making telehealth work well here:

http://medicalrepublic.com.au/practical-tips-for-doing-telehealth-well/26261

What would be ideal would be a thorough evaluation after 3-4 months of experience and then use of the evaluation to fine tune the technology and regulations / rules.

What do you think?

David.

AusHealthIT Poll Number 520 – Results – 29th March, 2020.

Here are the results of the poll.

Do You Believe The #myHealthRecord System Will Make A Useful Contribution In The Present COVID-19 Health Emergency?

Yes 9% (12)

No 91% (128)

I Have No Idea 0% (0)

Total votes: 140

The vast majority don’t believe the #myHealthRecord has much to offer at all in this emergency.

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

A really great turnout of votes.

It must also have been a very, very easy question as only 0/140 readers were not sure how to respond.

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

David.

Saturday, March 28, 2020

Weekly Overseas Health IT Links – 28 March, 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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Data Platform Tracks Hospital Bed Capacity During COVID-19 Outbreak

Definitive Healthcare and Esri have launched a data platform that tracks US hospital bed capacity during the COVID-19 pandemic.
March 19, 2020 - Definitive Healthcare has partnered with Esri to launch an interactive data platform that allows people to analyze and monitor US hospital bed capacity, as well as potential geographic areas of risk, during the COVID-19 outbreak.
The resource shows the location and number of licensed beds, staffed beds, ICU beds, and total bed utilization rates in the US.
Dig Deeper
In addition to Definitive Healthcare’s US Hospital Bed data resource, the Esri COVID-19 GIS Hub contains other important information, including an overlay of US Census data to help leaders compare the surrounding US population with the total number of available hospital beds.
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Coronavirus spread has ‘kicked NHS forward in adopting digital solutions’

The rapid spread of coronavirus has given the NHS a “kick forward” in the need to accelerate technology and ensure staff are digitally prepared, a GP has said.
Andrea Downey 13 March 2020
Neil Paul, a Digital Health columnist and GP in Ashfields, said the need to reduce face-to-face appointments to prevent the potential transmission of Covid-19 has forced the NHS, particularly in primary care, to adopt already available technologies.
He said practices “still in the stone ages” and “technophobes” were less prepared for the current situation, but that it would force them to move into the digital age.
“It’s absolutely made my surgery go ‘right, how do we do online consults’. I think it actually has given people a real kick forward,” he told Digital Health News.
“What’s really interesting is I’ve been doing some conversations with patients on Facebook and they are sort of saying ‘Well why weren’t we doing this before?’.
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EMIS makes GP video consultation service free in coronavirus fight

EMIS has made its video consultation service free to all GPs running its clinical software in a bid to help tackle the spread of coronavirus.
Owen Hughes 18 March, 2020
Four thousand GP practices running EMIS Web now have the capability to offer video consultations to their patients, who can access the service via the free Patient Access app.
The Video Consult service is being offered at no cost to practices for a temporary period of 12 weeks, with EMIS also providing online training and support materials to GPs.
The aim is to help GPs reduce the number of visits to surgeries – preventing the risk of practice closure and ensuring vital GP services remain in place.
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Microsoft Teams to be rolled out across NHS in response to coronavirus

Microsoft Teams is being rolled out across the entire NHS to support remote working during the coronavirus outbreak, Digital Health News can reveal.
Owen Hughes – 18 March 2020
Between 16 – 20 March, all users of NHSmail in England and Scotland will be given access to Teams, the Microsoft workplace collaboration platform that forms part of the Office365 suite.
The roll-out of the software has been accelerated to help NHS teams better communicate and collaborate around their responses to Covid-19, and counter the increased risks associated with the virus.
Microsoft Teams enables users to send instant messages, make internal calls, share, edit and collaborate on files and documents in one central, secure location.
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The Value and Ethics of Using Phone Data to Monitor Covid-19

03.18.2020 03:44 PM
Google and Facebook are discussing plans with the White House to share collective data on people's movements during the coronavirus pandemic.
Google and Facebook are considering efforts to analyze the collective movements of millions of users to determine how the deadly novel coronavirus is spreading across the US, and to gauge the effectiveness of calls for social distancing.
The results could be shared with government agencies working to head off what could become an unprecedented public health emergency over the next few weeks. Those with knowledge of the plans say every effort is being made to protect user privacy by anonymizing the data. They say a rough picture of how people are gathering and moving around could prove vital to combating the virus, which threatens to overwhelm US hospitals if the current rate of transmission does not change.
Still, the plan may test people’s attitudes toward privacy and government surveillance, amid growing concerns about the ways in which big tech companies track their users. Some companies already share some aggregate data, but it would be new for Google and Facebook to openly mine user movements on this scale for the government. The data collected would show patterns of user movements. It would need to be cross-referenced with data on testing and diagnoses to show how behavior is affecting the spread of the virus.
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Vietnam’s hospitals at the early stage of going smart

While public hospitals aim to improve their operational efficiency and medical outcomes, private hospitals are making a digital push to enhance their value proposition.
March 20, 2020 04:12 AM
According to the latest white paper by YCP Solidiance, an Asia-focused consultancy firm, titled A Look Forward: How Digitalization is Transforming Vietnam’s Healthcare System, the country’s hospitals are in the early phase of going smart. While public hospitals aim to improve their operational efficiency and medical outcomes, private hospitals are making a digital push to enhance their value proposition.
Current developments: Public hospitals
As of July 2019, 100% of public hospitals have installed hospital information system (HIS). While some hospitals have an internal information technology team to develop HIS internally, the majority (>92%) utilize solutions developed by local IT companies such as FPT, Links Toan Cau, Dang Quang, and OneNet, amongst others, the white paper reported.
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How EHR vendors are arming providers to handle COVID-19

Healthcare IT News presents a look at the new capabilities popular EHR vendors are adding, along with helpful links to additional tech info and coronavirus resources.
March 20, 2020 12:45 PM
As healthcare organizations ramp up efforts to treat COVID-19 patients, their health IT vendors are looking to provide them with tools to manage cases, analyze data and assess patients remotely.
The nation’s largest vendors of electronic health records systems have augmented their existing systems over the last three months to give users of its systems more tools to cope with the crisis.
In addition to equipping customers, the HIT vendors are taking steps to protect their workforces from infection by implementing work-at-home policies and issuing guidelines for sick employees, whether they have COVID-19 or some other illness.
What follows are some of the tools and capabilities that EHR vendors have added to providers’ arsenals in dealing with the pandemic.
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MIT’s Safe Paths Aims to Inform Individuals About COVID-19 Where They Live

March 20, 2020
Although the COVID-19 pandemic is by definition a worldwide crisis, it is still distributed in a very skewed manner–and it would help us to know better where it is. A team run out of MIT is working on this at a very detailed, grass roots level though an interesting system called Safe Paths. Although public health authorities and clinicians want information that will help them apportion resources and recommend actions, Safe Paths is directed toward individuals. It lets you ask: Have I recently crossed paths with an infected individual? Was somebody in the grocery store or post office around the same time I was?
Naturally, the best way to save lives is to minimize all physical contact. Those trips to public places should be done only for critical needs. But most of us have been lax until recently, and many (although no one reading this article, I trust) are still being lax. The Safe Paths developers wants to help us look back in time and assess just how much danger we have been in. Their rationale and method are discussed in a white paper.
The process begins with a person who is diagnosed with the disease or learns that she should self-isolate because she was in contact with a carrier. At that point, she should download an app called Private Kit from MIT, available on IoS and Google Pixel. The app creates a history of the individual’s movements, based on the times and locations of the phone over a period of days or weeks.
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In Clever Move, Orbita Releases Free COVID-19 Chatbot

March 20, 2020
As the public becomes steadily more anxious about COVID-19, healthcare providers are getting swamped with questions about the virus. They’re also struggling to screen both at-risk and symptomatic patients, a necessary step in triaging them and directing them to the appropriate level of care.
In response to this concern, healthcare voice assistant vendor Orbita has developed a COVID-19 Virtual Assistant which addresses both concerns. The Assistant comes loaded with conversationally formatted Q&A and screening content drawn from the CDC and other clinically screened content.
What makes this offering sweet for Orbita is that it leverages the company’s proprietary platform. The COVID-19 chatbot can be adapted to serve as a mobile bot, smart speakers such as the Amazon Echo, SMS and analog phones. It can also be integrated with telemedicine and visit scheduling systems already in place within the provider’s IT infrastructure. However, this can only be done if the provider uses the Orbita platform.
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OCR Shares COVID-19 Cyber Scam Advice, as Hackers Impersonate WHO

Hackers are taking advantage of the COVID-19 outbreak by impersonating WHO in coronavirus phishing campaigns. In response, OCR urges providers to review DHS cyber scam advice.
March 18, 2020 - The Office for Civil Rights issued an alert for healthcare providers urging them to review recent COVID-19 cyber scam guidance from the Department of Homeland Security, as hackers continue to target users with coronavirus phishing campaigns.
Healthcare providers are being warned to stay vigilant for these types of scams first outlined by DHS’ Cybersecurity Infrastructure Security Agency on March 6.
Cybercriminals are sending emails with malicious attachments or links to fraudulent websites in an attempt to gain access to sensitive information. As a result, organizations should be cautious when handling emails with subject lines, attachments, or hyperlinks related to Coronavirus, or COVID-19.
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March 19, 2020 / 12:29 AM / a day ago

FDA urges virtual patient visits as coronavirus disrupts clinical trials

 (Reuters) - The U.S. Food and Drug Administration on Wednesday recommended switching to virtual patient visits instead of in-person monitoring for clinical studies, as signs emerge that the rapid spread of the coronavirus outbreak is disrupting trials.
FILE PHOTO: A view shows the U.S. Food and Drug Administration (FDA) headquarters in Silver Spring, Maryland August 14, 2012. REUTERS/Jason Reed
U.S.-based Iveric bio Inc (ISEE.O) delayed enrolment in a trial of its eye disease drug on Wednesday, two days after Provention Bio (PRVB.O) paused a study of its diabetes drug but allowed trial patients to complete their course.
The companies said these measures were taken to ensure the safety of the patients being tested and the medical staff.
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Patients Want Full Health Record Access With Added Security

A majority of respondents from a Pew Charitable Trust focus group would like full access to their healthcare records, but have privacy and security concerns.
March 18, 2020 - Patients want enhanced data sharing for providers and patients, but they also stressed the importance of patient data privacy and security, according to a Pew Charitable Trust focus group.
Focus group respondents, who had an array of health issues, said patients should receive all information from providers. Respondents also agreed providers should be able to exchange all patient information between themselves. This would also include data about substance use history, behavioral or mental health, and social factors. However, some participants did raise privacy and security concerns.
The focus groups concentrated on the new regulations from the Office of the National Coordinator of Health IT (ONC) that would boost health information exchange, give patients more access to their health data, specifically on their cellphones, and eradicate information blocking.
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Cyberattack on Czech hospital forces tech shutdown during coronavirus outbreak

The hospital has one of the largest COVID-19 testing facilities in the Czech Republic.
March 19, 2020 06:58 AM
Brno University Hospital in the Czech Republic was hit by a major cyberattack on 12 and 13 March, causing an immediate computer shutdown in the midst of the coronavirus outbreak.
The hospital, which has one of the largest COVID-19 testing facilities in the Czech Republic, was forced to cancel operations and relocate new patients to other hospitals.
WHAT HAPPENED
The infection was initially reported at 5AM on 13 March, when the hospital decided to disconnect all computer networks.
“Gradually, the individual systems were falling, so all computers had to be shut down,” said hospital director Jaroslav Å terba.
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Telemedicine during COVID-19: Benefits, limitations, burdens, adaptation

Telehealth tech is in the spotlight for coronavirus care. And it’s helping. But what are its limitations, and how are hospitals adapting?
March 19, 2020 03:09 PM
As the COVID-19 virus wreaks havoc with the healthcare system, telemedicine is stepping up into the spotlight and helping healthcare provider organizations and caregivers better respond to the needs of Americans who have contracted the virus and Americans who need to touch base with their providers on the status of their health.
Telemedicine is making a very positive contribution to healthcare during the pandemic, and is being used in a variety of ways. But telehealth technologies do have certain limitations when it comes to treating patients during a pandemic. Further, there is a chance telemedicine could add to hospitals being overwhelmed, unless it’s used well. But hospitals are learning to adapt to telehealth during a pandemic.

How telemedicine is being used in the context of COVID-19

During this global pandemic, telehealth is emerging as an effective and sustainable solution for precaution, prevention and treatment to stem the spread of COVID-19.
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COVID-19 Outbreak Threatens Health Systems With New Financial Challenges

By Jack O'Brien  |   March 19, 2020
The rapid spread of coronavirus has U.S. hospitals faced with several issues related to operating margins, revenue collection, and reimbursement for treating patients with this disease.
Within the past two weeks, coronavirus disease 2019 (COVID-19) has significantly disrupted the American way of life, sinking the country's economic system and placing hospitals under unprecedented financial and clinical stress.
The coronavirus has spread throughout all 50 states and the District of Columbia, accounting for over 7,000 confirmed cases and nearly 100 deaths, according to the Centers for Disease Control and Prevention as of Thursday afternoon.
As a result of COVID-19, which the World Health Organization declared a pandemic last week, hospitals and health systems are faced with a critical challenge to their operations and overall business model.
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As HHS Responds to Coronavirus, Network Targeted by Cyberattack

The HHS network was bombarded with millions of hits late Sunday night, in an apparent attempt to undermine the agency’s coronavirus response; a foreign threat actor is suspected.
March 17, 2020 - The Department of Health and Human Services faced a targeted cyberattack on its network Sunday night. Hackers launched a disruptive disinformation campaign designed to impede the agency’s coronavirus response, first reported by Bloomberg.
HHS Spokesperson Caitlin Oakley explained that the HHS team first saw a significant increase traffic on the cyber infrastructure on Sunday.
Fortunately, the hacking attempt failed to significantly slow the network and did not manage to penetrate the network, despite the threat actors sending millions of hits over several hours.
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Artificial Intelligence Identifies High-Risk COVID-19 Patients

Medical Home Network is using artificial intelligence to identify Medicaid patients who are most at risk from COVID-19.
March 16, 2020 - Medical Home Network, an organization serving patients in the Chicago area, is using artificial intelligence to identify individuals who have a heightened vulnerability to severe complications from COVID-19.
For Medicaid beneficiaries who face challenges such as homelessness or lack of transportation access, it can be difficult to take measures to protect against or receive treatment for COVID-19. Medical Home Network is leveraging an AI-based predictive analytics model to prioritize care management outreach to patients most at risk from the virus.
“We want to identify what we refer to as the 'socially isolated' or people without nearby friends or family so our care teams can proactively educate and offer assistance to people in regards to COVID-19,” said Dr. Art Jones, Chief Medical Officer at Medical Home Network. 
Medical Home Network’s Accountable Care Organization (MHN ACO) provides managed healthcare to approximately 120,000 patients in Cook County. MHN ACO aims to provide patients with better care through coordinated care management at the practice level.
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A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

By John P.A. Ioannidis
March 17, 2020
The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.
At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.
Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?
Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.
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HHS cyberattack highlights how hackers are exploiting the pandemic. Here are 4 strategies to mitigate the risks

Mar 17, 2020 5:23am
Healthcare organizations have long been the targets of hackers.
But amid the coronavirus pandemic, cybersecurity experts are raising the alarm about an increase in cyberattacks as hackers exploit the outbreak's disruption.
Among the top targets: government agencies critical to responding to the epidemic.
Hackers tried to breach the U.S. Department of Health and Human Services' (HHS) computer system Sunday night, both Bloomberg and ABC News reported. HHS Spokesperson Caitlin Oakley told FierceHealthcare the department became aware of a significant increase in activity on HHS cyberinfrastructure on Sunday.
The department is "fully operational" as it actively investigates the matter, Oakley said. HHS officials said there was no data breach.
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ONC's Rucker: Interoperability puts American consumers in control of healthcare

Mar 18, 2020 12:12pm
Giving patients access to their health data on their smartphones will open up new business models of healthcare, the head of the Trump administration's health IT policy arm said this week. 
On March 9, the Department of Health and Human Services issued two rules, one each by the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS), that implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act.
The ONC's information blocking rule (PDF) requires that electronic health data be made available to patients at no cost and defines exceptions to data blocking.
Speaking about recently released interoperability regulations, Donald Rucker, M.D., the national coordinator for health IT, said the rules will "materially change the state of patient care and patient control over their health data" and will create a healthcare app economy.
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Health Catalyst unveils two systems and a service for COVID-19 response

The healthcare analytics vendor's systems and service are focused on patient tracking, public health surveillance and staff-augmentation support.
March 18, 2020 11:38 AM
Health Catalyst, a vendor of healthcare analytics technology and services, after numerous conversations with health system clients, will offer two COVID-19 systems and a new service to its domestic clients, with the first system available to pilot clients by the end of the month.
The technology associated with these systems will be offered to all clients at no incremental cost through the end of 2020. In the weeks ahead, Health Catalyst will continue to explore with clients additional potential analytics systems helpful in addressing the COVID-19 situation.
The first system, Patient & Staff Tracker, is a tailored module of Health Catalyst’s Patient Flow Analytics Accelerator that offers health systems the ability to track where patients who test positive for COVID-19 have been within the health system setting, and which staff members have interacted with these patients, to inform capacity management, testing, quarantine and decontamination activities.

Automatic, not manual

Many health systems are compiling this information manually today. This new system automates the process and produces a straightforward and actionable report, the vendor said. Health Catalyst is making this technology module available to all health system clients at no incremental cost, with any associated additional services offered at a discounted rate through the end of 2020.
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‘Much better data and technology’ to aid UK in fight against new coronavirus, PM says

The number of confirmed cases in the UK went up to nearly 2,000 on Tuesday.
March 18, 2020 06:43 AM
More testing, more beds, further support for health and care staff and “much better” data and technology will be key in increasing the capacity of the NHS as the number of confirmed cases of COVID-19 continues to increase in the UK, prime minister Boris Johnson said yesterday.
The PM gave an update on the government’s approach to tackling the pandemic in a second daily televised press conference following widespread criticism during the weekend over a lack of transparency and communication with the public.
On Monday, Johnson told Britons to avoid restaurants, pubs and non-essential travel and contact with others. The advice, he continued, was “particularly important” for pregnant women, those with underlying health conditions and people over the age of 70.
The PM also advised households to self-isolate for 14 days if one person developed a fever or a continuous cough, and warned yesterday that the UK might have to go “further and faster” over the next couple of days to deal with the new threats.
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NHS Digital to deliver new services, use data ‘more efficiently’ in latest effort to tackle coronavirus pandemic

The news comes as the number of confirmed cases in the UK jumped to over 2,600 as of the morning of 18 March.
March 18, 2020 11:33 AM
Health secretary Matt Hancock and NHS England have asked NHS Digital to undertake a series of actions that would support the UK's efforts to tackle the COVID-19 pandemic, the agency said on Tuesday.
Experts will collect and analyse data aiming to help professionals understand COVID-19 better and identify patients that have it or that are vulnerable to the disease as part of the UK’s response to the crisis.
The agency, which is the national information and technology partner of the health and care system, said new legal directions from the government enabled them to work on delivering new services and use data “more efficiently”. This includes looking at how the health service is responding to threats posed by the coronavirus.  
“This is a rapidly moving situation and data is key to helping us understand how best to protect individuals at risk, know what is happening to patients and ensure that the NHS under pressure can deliver effectively,” said Dr Jem Rashbass, executive director of master registries and data at NHS Digital.
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Final Interoperability Rule Has Implications for APIs, FHIR

The final interoperability rule will boost the seamless exchange of data through new application program interfaces (APIs) and FHIR standards.
March 12, 2020 - Earlier this week, the Office of the National Coordination for Health IT (ONC) announced a new interoperability rule which requires certified health IT developers to establish secure, standards-based application programming interfaces (APIs) to support patient’s access to vital data in their electronic health record (EHR).
The 21st Century Cures Act: Interoperability, Information Blocking final rule and the ONC Health IT Certification Program Final Rule aims to provide patients with transparency into the cost and outcomes of medical care and ensure convenient health data access on computers, cell phones, and mobile applications. 
The new rule uses modern day technology to promote patient access to electronic health information (EHR), support provider needs, and advance industry-wide information blocking practices. 
“The need is evident. We use technology in so many facets of life. We send email, buy airline tickets, keep up with friends and family on social media, and order food from the convenience of our smartphones,” said Elise Sweeney Anthony, executive director of policy at ONC. 
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Coronavirus model shows individual hospitals what to expect in the coming weeks

March 16, 2020
Spurred by reports of doctors in Italy rationing ventilators for coronavirus patients and of overwhelmed hospitals throughout Europe, data scientists have built a mathematical model to help hospitals forecast what they might be facing in the days or weeks to come, based in part on the number of Covid-19 cases in their area.
That model, first offered to administrators at University of Pennsylvania hospitals, shows they could exceed capacity within weeks but, crucially, that social distancing measures now being implemented could avert that, a clear demonstration of the power of countermeasures being adopted by elected officials and others.
“The intention is to see what the capacity requirements for hospitalization, intensive care, and ventilators might be,” said Penn data scientist Corey Chivers. “The more we can get a handle on whether capacity is too low for what an area can expect, the more a hospital system can take steps” to address that shortfall.
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With launch of COVID-19 data hub, the White House issues a ‘call to action’ for AI researchers

Taylor Hatmaker@tayhatmaker / 6:15 am AEDT March 17, 2020
In a briefing on Monday, research leaders across tech, academia and the government joined the White House to announce an open data set full of scientific literature on the novel coronavirus. The COVID-19 Open Research Dataset, known as CORD-19, will also add relevant new research moving forward, compiling it into one centralized hub. The new data set is machine readable, making it easily parsed for machine learning purposes — a key advantage according to researchers involved in the ambitious project.
In a press conference, U.S. CTO Michael Kratsios called the new data set the “most extensive collection of machine readable coronavirus literature to date.” Kratsios characterized the project as a “call to action” for the AI community, which can employ machine learning techniques to surface unique insights in the body of data. To come up with guidance for researchers combing through the data, the National Academies of Sciences, Engineering, and Medicine collaborated with the World Health Organization to come up with “high priority” questions about the coronavirus related to genetics, incubation, treatment, symptoms and prevention.
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How to Improve Patient Handoffs

By Brian Ward  |   March 13, 2020
Breakdowns in communication can cost lives and dollars. Here's what it takes to create smooth patient handoffs.
Botched patient handoffs can cause major problems for patients, hospitals, and health systems.  
A 2015 study by research and analysis firm CRICO Strategies found that communication errors accounted for over 1,700 deaths and $1.7B in additional costs to the healthcare system. Additionally, the study, which analyzed 23,000 medical malpractice claims filed between 2009 and 2013, found communication problems were contributing factors in 7,149 cases (30%). 
Handoffs can break down in intense situations (air-lifting a trauma patient to a specialty hospital) and in more routine tasks (change of nursing shift). So, how can healthcare professionals improve communication during these daily occurrences?
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A fake coronavirus tracking app is actually ransomware that threatens to leak social media accounts and delete a phone's storage unless a victim pays $100 in bitcoin

Antonio Villas-Boas
Mar 17, 2020, 4:10 AM
  • The concerns surrounding the coronavirus outbreak are being exploited by hackers taking advantage of people’s thirst for information.
  • An Android app called “COVID19 Tracker” is just one example of ransomware that masks itself as a real-time coronavirus map tracker, according to researchers.
  • If a user grants the app access to certain phone settings, the ransomware is enabled and locks the user ouf of their phone unless they pay $US100 in bitcoin to the hackers within 48 hours.
  • If the victim doesn’t comply, the ransomware threatens to delete their phone’s storage and leak social media accounts.
  • The website that hosts the ransomware app appears to have been taken down. The app isn’t found on the Google Play Store, where the risk of downloading malware is significantly lower.
  • Visit Business Insider’s homepage for more stories.
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The US lacks health information technologies to stop COVID-19 epidemic

Niam Yaraghi Friday, March 13, 2020
The COVID-19 pandemic highlights the crucial importance of health information technology and data interoperability. The pandemic has shattered our common beliefs about the type and scope of health information exchange. It has shown us that the definition of health data should no longer be limited to medical data of patients and instead should encompass a much wider variety of data types from individuals’ online and offline activity. Moreover, the pandemic has proven that healthcare is not local. In an interconnected world, with more individuals traveling long distances than ever before, it is naïve to look at regions in isolation from each other and try to manage public health independently. To efficiently manage a pandemic like this, the scope of health information exchange efforts should not be limited to small geographical regions and instead should be done at least nationally, if not internationally.

Health data should go beyond medical records

A wide variety of factors affect one’s overall well-being, a very small fraction of which could be quantified via medical records. We tend to ignore this fact, and try to explain and predict a patient’s condition only based on medical data. Previously, we did not have the technology and knowledge to collect huge amounts of non-medical data and analyze it for healthcare purposes. Now, privacy concerns and outdated regulations have exacerbated the situation and has led to a fragmented data ecosystem. Interoperability, even among healthcare providers, remains a major challenge where exchange and analysis of non-medical data for healthcare purposes almost never happens.
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COVID-19 News

England’s Imperial College COVID-19 response team self-publishes a paper whose impact is reverberating around the US and UK, with the White House getting an early look a week ago that may have influenced its 180-degree turnaround in how the pandemic is viewed and managed. The team describes two strategies for the two countries: mitigation (flattening the curve to reduce peak healthcare system demand) and suppression (reversing growth and case numbers in an indefinite program will awaiting development of a vaccine). Summary points:
  • Mitigation, such as home isolation of suspected cases and social distancing of high-risk people – is not preferred. It could reduce peak healthcare demand by two-thirds and cut deaths in half, but would still result in hundreds of thousands of deaths and overwhelmed hospitals, particularly in terms of ICU beds.
  • Suppression, as was practiced in China, requires social distancing of the entire population, home isolation of cases, and household quarantines, possibly supplemented with closing all schools. The practice would need to continue until a vaccine can be developed and produced in adequate quantity to treat the entire population, which could take 18 months or more. A compromise may be to regionally relax and tighten social distancing based on public surveillance case numbers.
  • In the absence of any action, the computer model suggests that peak US deaths will occur in June, 81% of the population will be infected, and 2.2 million people will die (not counting those whose deaths from other causes are related to overwhelmed hospitals). ICU bed capacity will be exhausted by the second week of April and demand will peak at 30 times the available number of ICU beds.
  • A strong surge is likely again in the fall, so action now is urgent.
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Biofourmis' AI-fueled remote monitoring tech provides insights in fight against COVID-19

Program administered by the University of Hong Kong has international implications and applications; clinicians leverage wearables and AI to accelerate disease surveillance and interventions.
March 13, 2020 12:11 PM
Biofourmis, a developer of digital therapeutics aimed at personalized care, says its technology is being used in a remote-monitoring and disease-surveillance program in Hong Kong involving patients with diagnosed or suspected novel coronavirus disease (COVID-19).
The program, administered by the University of Hong Kong, also includes Hong Kong-based Harmony Medical, which is Biofourmis’s joint-venture partner for the China region.
WHY IT MATTERS
Patients potentially infected with COVID-19 are being monitored with the Biofourmis Biovitals Sentinel platform, a system the company built in less than two weeks specifically for this initiative by customizing its FDA-cleared artificial intelligence-powered Biovitals Analytics platform.
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Health system uses telehealth to steer patients away from ER, urgent care

At WakeMed Health and Hospitals, 61% of patients who used virtual urgent care would have gone to an urgent care facility; 14% would have gone to an emergency room.
March 17, 2020 12:33 PM
WakeMed Health and Hospitals is based in the heart of a dynamic, fast-growing market – an area known as the Triangle, which includes Raleigh and Durham, North Carolina, and surrounding communities. This area has made a name for itself – renowned universities, constant opportunity, cutting-edge technology and an impressive range of health services and healthcare options.
THE PROBLEM
Hospitals and health systems across the country are rolling out telemedicine services for patients. The existing landscape of telehealth vendors means there certainly is no shortage of plug-and-play options, but WakeMed Health’s goal in implementing virtual care was to not only provide more access and options for high-quality care, but also to engage with more residents in the community and across the state, and make the healthcare experience easier for everyone involved.
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Expansion of Medicare Coverage and Payment for Telehealth Visits During COVID-19

March 17, 2020
CMS has announced the expansion of Medicare coverage and payment for telehealth and telemedicine visits. This coverage and payments were granted under the President’s emergency declaration and this expanded benefit is on a temporary and emergency basis under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act starting March 6, 2020. This was an expansion of what was already being reimbursed on a limited basis in rural areas.
The telehealth payments cover three types of telemedicine visits: Medicare Telehealth Visits, Virtual Check-ins, and E-Visits. Here are the key takeaways from all 3:
Medicare Telehealth Visits
  • Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
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HIPAA Penalties Suspended for Telehealth During Covid-19 National Emergency

March 17, 2020
Today, the Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) issued the news that enforcement of HIPAA penalties around telehealth, patient communication, and remote communication technologies will be suspended during the Covid-19 National Emergency and will go into effect immediately.
Here’s the official wording from the announcement:
OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately.
The announcement goes on to specify that healthcare providers can use any “non-public facing” remote communication product to communicate with patients. It goes on to note that the communication or service being provided the patient doesn’t have to be related to the coronavirus or Covid-19. The HIPAA exemption for use of telehealth applies to any healthcare service.
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Industry Voices—How health data could help with COVID-19 (if we can get it right)

Mar 13, 2020 10:00am
"I hope this is our wake-up call that American healthcare needs to work together," says Claudia Williams, the CEO of Manifest MedEx and a former senior adviser for health innovation and technology at the White House. (Getty/Bill Oxford)
I was relieved when HIMSS was canceled. We had already made the decision to withdraw to protect our team and so we can focus on continuing to help on the front lines of California healthcare as the statewide health data network. As public health leaders, it is our responsibility to make this kind of difficult choice. 
The work we lead at Manifest MedEx is designed for times of healthcare crisis. A real-time network for clinical and claims data is a fundamental piece of public health infrastructure.
These are interoperability systems that ideally we would have had in place a decade ago, but at least the acceleration of the past few years means that more than 20 million Californians are covered on our nonprofit network today.
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The suboptimal state of healthcare security – and how to improve it

An expert offers an in-depth look at where cybersecurity is in healthcare today and gives advice on how healthcare CIOs and CISOs can best protect their assets.
March 16, 2020 01:32 PM
Preparedness for data-privacy and security is too often lacking in healthcare-provider organizations, thanks to inconsistent levels of cybersecurity education and incredibly low cybersecurity budgets.
This is one reason that healthcare has consistently been one of the most breached industries in recent years. Many health IT and infosec teams still don’t have adequate insights about where their data lives, or even whether it has been exfiltrated or otherwise compromised.

Can providers really meet HIPAA requirements?

When it comes to privacy protections, unfortunately, most healthcare-provider organizations still cannot meet basic HIPAA requirements, much less those of the California Consumer Privacy Act (CCPA) or General Data Protection Regulation (GDPR).
As Terry Ray, a healthcare cybersecurity expert and senior vice president at Imperva, a data and application security vendor, explains: “Up until recently, and by recently, I mean the last three years, data privacy has been the purview of data owners, in essence, database administrators, specific medical specialty departments, even risk and legal teams. In highly regulated businesses, these teams were mandated to meet highly specific data privacy regulations.”
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COVID-19 shows why we must prioritize public health surveillance funding

Accurate outbreak data reporting depends on a robust, standards-based and interoperable information infrastructure. We still have a long way to go.
March 16, 2020 03:32 PM
During a pandemic like COVID-19, one of the most important tools for public health officials is a reliable system of quickly reporting accurate data about the outbreak from communities to states and the federal government so officials can rapidly identify and implement the most effective interventions.
This requires a standards-based interoperable system, which many jurisdictions across the U.S. still have not been able to implement, largely due to lack of federal funding and slow adoption of existing standards.
COVID-19 should be a wake-up call to finally invest the resources necessary to complete this important work.
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Coronavirus outbreak triggers wave of apps, online tools for diagnosis, testing

Startups and legacy tech vendors alike are developing array applications and web services to help people track the virus, check for symptoms and offer advice on ways to help prevent exposure.
March 16, 2020 10:55 AM
As the number of infections caused by the spread of the Coronavirus continues to rise worldwide, medtech startups, healthcare organizations, and others are bringing applications and online services to the market to help people track the virus, check for symptoms, and offer advice on ways to help prevent exposure or even offer testing methods that limit exposure risk.
Here’s a roundup of just a few of the latest resources out there, which will be updated:
Created by practicing medical physicians and developed by Fast Pathway, the DocClocker app enables patients to receive real-time wait-time reporting of their medical providers, in theory helping to prevent the spread of the virus by enabling patients to avoid long waits in medical waiting rooms, thereby limiting exposure risks.
Blue Spark Technologies launched TempTraq, a single-use, disposable temperature monitor in the form of a soft patch that continuously monitors and records axillary temperature and wirelessly transmits real-time data for up to 72 hours. Once placed on a patient, clinicians can remotely monitor temperatures with little-to-no direct contact, helping eliminate potential cross-contamination from shared temperature measurement devices.
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UPDATED: HHS fends off cyberattack as it fights coronavirus

The agency was subject to a hacking attempt on Sunday, designed to slow down its COVID-19 pandemic response and sow disinformation, Bloomberg reports.
March 16, 2020 12:26 PM
UPDATE: On Monday afternoon, HHS Spokesperson Caitlin Oakley issued the following statement:
"HHS has an IT infrastructure with risk-based security controls continuously monitored in order to detect and address cybersecurity threats and vulnerabilities. On Sunday, we became aware of a significant increase in activity on HHS cyber infrastructure and are fully operational as we actively investigate the matter. Early on while preparing and responding to COVID-19, HHS put extra protections in place. We are coordinating with federal law enforcement and remain vigilant and focused on ensuring the integrity of our IT infrastructure."
The U.S. Health and Human Services Department reportedly was targeted with a cyberattack on Sunday evening, complicating its efforts to coordinate nationwide response to the mounting coronavirus pandemic.
WHY IT MATTERS
Bloomberg news was the first to report that hack, which officials surmise was meant to hamper HHS' ability to respond to the ongoing public health crisis. 
Anonymous sources told the news outlet that the cyber intrusion – which reportedly involved a sustained attack with millions of hits to the agency's servers over the course of several hours – didn't cause any substantial damage to the health agency's response capabilities, and didn't result in the exfiltration of any data. 
HHS has not yet responded to a request for comment from Healthcare IT News.
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Coronavirus Shines Spotlight On Telehealth Delivery Problems

March 16, 2020
As the coronavirus threat has continued to grow, providers are making good use of their investments in telehealth. There have always been benefits to meet patients’ health needs with virtual visit tools, which keep care accessible while freeing up face-to-face resources for those that truly need them, but they’re especially important as infection rates rise.
However, there are still some significant challenges to relying heavily on telehealth services, problems which the COVID-19 outbreak has exposed as pressure mounts to treat those infected by the virus. While providers were already aware of these gaps, they’re getting more attention as demand for such services surges.
One interesting set of observations on this subject comes from Dr. Farzad Mostashari, former national coordinator with ONC and founder of Aledade. In a recent tweetstream, he called attention to some substantial challenges Aledade doctors are facing in using these tools.
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What Malpractice Liabilities Do Healthcare AI Users Face?

March 16, 2020
With many providers adopting AI technology, it’s likely that some of them will face medical malpractice suits blaming the AI for patient harm. While it’s still unclear how to tackle this problem, it’s clear that healthcare organizations will have to address it soon.
According to Saurabh Jah, who wrote a piece on this subject for Stat, it’s still not clear who or what is liable if a mistake fueled by AI harms a patient.
Consider, for example, of a hospital that uses AI rather than a radiologist to interpret chest x-rays. If the AI misses the presence of pneumonia, leading to patient death from septic shock, who’s responsible? Existing law offers some guidelines, but some important questions are far from settled.
On the one hand, if the hospital developed the algorithm in house, things are comparatively straightforward – the hospital will likely be on the hook through under the concept of enterprise liability. “Though the medical center isn’t legally obligated to have radiologists oversee AI’s interpretation of x-rays, by removing radiologists from the process it assumes the risk of letting AI fly solo,” he notes.
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Weekly News Recap

  • COVID-19 dominates the national and healthcare news.
  • Use of telemedicine ramps up to meet COVID-19 screening and management needs.
  • HealthjStream acquires nurse scheduling app vendor NurseGrid, which offers the #1 most downloaded app for nurses.
  • FormFast changes its name to Interlace Health.
  • Final versions of the federal government’s interoperability and patient access rules are published.
  • HIMSS announces plans to offer some HIMSS20 sessions virtually.
  • Organizers cancel most of their upcoming conferences due to coronavirus concerns, including AMIA.
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Enjoy!
David.