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Electronic health records were supposed to save money—and lives. So far, they’ve mostly made doctors angry.
June 11, 2015
When technology “disrupts” it creates winners and losers. Hello smartphone! So long camera, encyclopedia, newspaper, book, CD, courtship, attention span. Disruption isn’t just inevitable, it’s righteous. Question tech and you’re not only a relic, you’re a job-killer and a Luddite, and possibly a Unabomber.
The information technology tsunami has hit so fast that most of us haven’t had time to think about what we might be sacrificing by trying to ride it. And that’s particularly true when it comes to the delivery of health services.
With the best of intentions, the Obama administration six years ago launched the HITECH Act, a $30 billion program to put electronic health records (EHR) in every hospital and doctors’ office. It offered incentives for docs who bought and “meaningfully used” the technology, and penalties—which start to kick in this year—for those who failed to adopt the new technology quickly enough. The goal was to get doctors to store patient data and share it electronically with the patients, other physicians, public health agencies, laboratories and other players in the vast health care enterprise that accounts for one-fifth of our economy.
June 12, 2015 | By Katie Dvorak
Routine data can be a helpful tool in healthcare, but for such information to have a real impact--especially in the creation of a learning health system--certain challenges must be addressed.
Unlike information collected for research purposes, routine data is analyzed to help in the delivery of care for patients, a commentary on the trend published BMJ Quality and Safety discusses. Sometimes this data doesn't always show the full picture of the patient's health; the authors--from the London-based Health Foundation--call this a "data shadow" because often there is information that may be missing from a patient's record that has direct influence on their health.
Routine data can include administrative information such as reimbursement and contracting; clinically generated data, which includes information collected by healthcare workers to provide diagnosis and treatment; and some patient generated data that can be asked for by a clinician or offered up by the patient.
June 12, 2015 | By Marla Durben Hirsch
Cloud EHR vendor Medical Information Engineering (MIE) has revealed that it suffered a data breach affecting the electronic medical records of some of its clients' patients.
In a notice dated June 10, the Fort Wayne, Indiana-based vendor stated that it discovered suspicious activity May 26 related to one of its servers. MIE is investigating the incident and has reported it to law enforcement. The vendor also is reporting the incident to its affected clients, as well as to applicable federal and state authorities. Such clients include Concentra, Fort Wayne Neurological Center, Franciscan St. Francis Health Indianapolis, Gynecology Center, Inc., in Fort Wayne and Rochester Medical Group, as well as patients associated with MIE's NoMoreClipboard subsidiary.
The data potentially compromised includes patient names, Social Security numbers, lab results, medical conditions and other information; it does not include financial data, since the vendor doesn't collect or store such information.
Posted on Jun 12, 2015
By Michelle Ronan Noteboom, Contributing writer
"We the people want easy, electronic access to our health information."
That's the seemingly simple objective for supporters of Get My Health Data, a new initiative organized by former National Coordinator for Health IT Farzad Mostashari, MD.
Folks like ePatientDave, Regina Holliday, and other patient advocates have spent years fighting for better patient access to health data, but support for the movement has reached new heights, thanks to recently proposed changes to the meaningful use program.
In April, CMS stirred up the patient data access hornets' nest by proposing a modification to the Stage 2 meaningful use requirement that 5 percent of a provider's patient population views, downloads, or transmits their online health information.
JUN 12, 2015 7:19am ET
The minister of health in Ontario, Canada wants to double fines for breaches of patient medical information and remove a major barrier to investigating breaches.
Eric Hoskins is proposing new legislation to be introduced in the fall that would double maximum fines levied against individuals to $100,000, and against businesses to $500,000, multiple Canadian news outlets report.
The legislation if enacted as proposed would scrap a requirement that prosecutions resulting from a breach start no later than six months following the breach. The Canadian Press news service reports that because the requirement—introduced in 2004—is so tough to meet, only three cases have been referred for prosecution with one case unsuccessful and two others still being considered.
June 11, 2015 | By Susan D. Hall
Standards alone are not sufficient to achieve interoperability, according to David McCallie, M.D., senior vice president of medical informatics for Cerner.
McCallie, who also has served as a member of the Health IT Standards Committee since its beginnings in 2009, warns against the notion that nothing has been achieved in a guest post on the blog of Beth Israel Deaconess Medical Center CIO John Halamka.
"In particular, we have mostly settled the vocabulary questions for encoding the record," McCallie says. "We have widely deployed a good e-prescribing standard. We have established a standard for secure email that will eventually replace the fax machine, and we have widely [but not yet universally] deployed a good standard for document-centric query exchange."
Posted on Jun 11, 2015
By Bernie Monegain, Editor-at-Large
"We're here today to announce an intensive review of electronic health records," Sen. Lamar Alexander, chair of the Senate Committee on Health, Education, Labor & Pensions, announced at the start of a hearing before the panel Wednesday.
Alexander, R-Tenn., noted there is wide bipartisan interest in the issue. Patty Murray, D-Wash., a ranking member of HELP, has joined Alexander to form a working group on EHR usability.
It's not the first time Alexander has made his concerns over EHRs known to the committee. On Wednesday, though, he and Murray entered their remarks into the record and moved onto testimony from four invited experts.
9 June 2015 Thomas Meek
The NHS e-Referral Service will finally go live this Monday, replacing Choose and Book; but users shouldn't expect major changes until later in the summer.
In a conference call this afternoon (Tuesday), the Health and Social Care Information Centre said the transition will begin on the evening of Friday, 12 June and continue over the weekend, with new the service available from the morning of Monday, 15 June.
Stephen Miller, medical director for the e-Referral Service project, said he expected that every person who is able to use Choose and Book on Friday evening would be able to use the new system on Monday morning "with no additional training”.
Thursday, June 11, 2015
Health Datapalooza used to be the most exciting event in health IT, but this year a torpor hung over it. I confirmed this feeling with numerous colleagues and traced it to a few different trends, some within control of the conference organizers and some outside it.
The essential problem, many of my friends agreed, is that the applications market and other signs of progress in health IT are taking too long to launch. Many excellent building blocks are falling into place in both technology (DirectTrust and FHIR) and policy (recent announcements by CMS, as well as private insurers, that they will greatly increase risk sharing and pay-for-value). But these are slow to produce change.
In former centuries, religious fanatics would sell off all their possessions in expectation of the Messiah's imminent arrival. These believers' disappointment must have resembled that of current health entrepreneurs who sink their life savings into a company promoting some innovative health care reform and who then wait for the market to come around to their solutions.
Legal uncertainties and challenges with interoperability and usability have kept many healthcare providers from embracing systems for electronic prescribing of controlled substances.
CIO | Jun 11, 2015 3:51 AM PT
WASHINGTON -- If health technology is ever going to achieve the goal of lowering the rates of prescription drug abuse, developers and policy makers will have to do more to encourage adoption of electronic prescribing systems among healthcare providers.
More than 500 top IT leaders responded to our online survey to help us gauge the state of the
In a panel discussion here at a recent health IT conference, experts agreed that e-prescribing tools can help curb abuse of controlled substances by limiting drug diversion and doctor shopping, as well as cracking down on physicians who prescribe drugs for non-medical purposes.
Posted on Jun 10, 2015
By Scott Rea, DigiCert
The massive data breaches that struck CareFirst Blue Cross and Blue Shield, Anthem and Premera over the past year have sounded an alarm among healthcare IT. And with hackers eager to steal valuable patient data, it’s time the healthcare sector act more aggressively to secure private data.
Consider that, according to research from Gartner, close to 40 million healthcare records have been breached to date. That number, Gartner’s research suggests, is a conservative estimate because it takes into account only breaches of at least 500 individuals at a time.
And, the cost of a healthcare breach continues to climb, according to the Ponemon Institute, to about $363 per exposed personally identifiable record. That’s more than double the average cost of a data breach in other industries, and the trend holds across 11 industrialized nations. Our industry is a target, and we must do more now.
Spending growth in the $2.9 trillion US health economy is expected to slow in 2016 as compared to 2015; however, it will still outpace overall economic inflation. Stock prices, earnings reports and the customer base have increased and that means the industry is financially healthy. Sadly, affordable healthcare remains out-of-reach for many consumers.
PwC’s Health Research Institute (HRI) projects the U.S. healthcare spending growth rate will dip to 6.5 percent in 2016, capping a ten-year trend of slowing employer medical cost-trend growth in the employer-sponsored market. For this research, HRI interviewed industry executives, health policy experts and health plan actuaries whose companies cover more than 100 million employer based members. HRI also analyzed results from PwC’s 2015 Health and Well-being Touchstone survey of more than 1,100 employers from 36 industries and a national consumer survey of more than 1,000 US adults.
This time last year, things were looking up for e-prescribing, with NHS England apparently managing the market for a big roll-out through the tech funds. Then tech fund 2 was effectively cancelled. Kim Thomas asks whether the benefits of e-prescribing are enough to see it implemented, anyway.
This time last year, the future looked bright for e-prescribing in the NHS. The announcement of the ‘Safer Hospitals, Safer Wards: Technology Fund’ (tech fund 1) and then the ‘Integrated Digital Care Fund’ (tech fund 2) promised to introduce digital technology into one of the few NHS activities still largely untouched by IT.
As Lyn Whitfield reported, it looked as if about 80-90 trusts would soon be in the market for e-prescribing systems. But it was, in the words of Paul Thomson, e-prescribing lead at Ascribe, a “false dawn”.
Health secretary Jeremy Hunt’s March decision to slash the funding for tech fund 2 from £240 million to just £43 million brought the process skidding to a halt.
It leaves NHS England “behind the curve”, says Thomson: “The other NHS regions are powering ahead with this, so it just surprises us.” Robyn Tolley, managing director of NoemaLife, agrees, describing the decision as “bitterly disappointing” for the industry.
Hannah Galvin, MD
Jun 05, 2015
A lot of people complain about adolescents. They don’t listen. They act out. They talk like they have it all figured out. I disagree. As a pediatrician, this is my favorite group of patients. They have developed cognitively to be aware of the world’s complexities, and yet are still open to guidance as you help them navigate their way through. Adolescence can be challenging, but it is also an exciting time filled with potential.
I remember sitting with one particular 16-year-old girl, her shoulders slumped, eyes glued to sneakers, as I asked about her marijuana use and sexual activity. Gently, with a tolerance for the silence, a sense of humor, and a carefully placed curse word, I was able to earn her gaze. And she, in turn, was gradually able to disclose underlying symptoms of depression, for which we started treatment. Discussion of sensitive issues takes a delicate touch and a trustworthy provider, one who understands the privilege it is to bear such an influential role in someone’s life.
JUN 9, 2015 7:08am ET
At its annual meeting on Monday, the American Medical Association adopted a new policy to provide medical students with “hands-on” experience with electronic health records to improve patient care and increase the accuracy of clinical communications.
Specifically, AMA’s policy recommends that medical students—with appropriate supervision—learn as part of their education how to document patient encounters and enter clinical orders into patients' EHRs. Towards that end, AMA has committed to working with medical school accreditation bodies to support U.S. medical schools, as well as residency and fellowship training programs, in teaching students how to use electronic devices in the examination room and at the hospital bedside.
The new policy calls for “determining the characteristics of an ideal software system” for teaching EHRs to students that could be used at medical schools and teaching hospitals.
June 9, 2015 | By Susan D. Hall
Healthcare companies and organizations must not focus solely on technology when it comes to protecting sensitive information, according to privacy and security expert Kate Borten.
"There is nowhere near a single silver bullet," says Borten, founder of privacy and security consultancy The Marblehead Group, in an interview with HealthcareInfoSecurity. "Anyone involved with an information security program understands that there are a gazillion strategies, controls and safeguards to protect data."
Prior to founding Marblehead, Borten led the enterprisewide security program at Massachusetts General Hospital in Boston and established the first information security program at Beth Israel Deaconess Medical Center. She urges organizations to also consider physical security and notes that many of the controls required with HIPAA are administrative ones.
By: Jonah Comstock | Jun 8, 2015
A new survey of 1,200 consumers with either self- or employer-sponsored health insurance — sponsored by HealthMine and conducted by Survey Sampling International — indicates that interest in payer-led mobile health initiatives is still fairly low.
Although 89 percent of respondents use a smartphone, tablet, or both, only 30 percent of those surveyed said they would participate in a program offered by their wellness program that would require them to use a mobile app to track or monitor their health. And only 18 percent said they liked to learn health, wellness, and lifestyle information from a mobile app.
“Even though mobile applications have incredible potential to help consumers manage their health, they are still in the early stages of growth.” Bryce Williams, CEO and President of HealthMine, said in a statement. “As plan sponsors evaluate apps for their wellness programs, they should look for those that incorporate actionable clinical data and personalization to increase engagement. But we’re still waiting for the ultimate oxymoron: a ‘killer app’ for wellness.”
June 8, 2015 by David Raths
Does health data usage not covered by HIPAA need more oversight?
The Privacy and Security Workgroup of the Health IT Policy Committee is preparing a set of recommendations about how the Office of the National Coordinator for Health IT should approach “big data” issues for both HIPAA-covered entities as well as for the marketplace outside the HIPAA sphere.
At a June 8 meeting, Deven McGraw, a partner in the healthcare practice of Manatt, Phelps & Phillips, LLP and the workgroup’s chair, led a discussion of draft recommendations to identify gaps in law and regulation around issues including data de-identification and security as well as areas for further inquiry.
McGraw noted that outside the HIPAA-covered space, there is not a clearly defined right for patients to access data collected about them. She said there has been a debate with respect to medical devices, such as one patient who made a public argument that he had the right to access data from his pacemaker. The workgroup proposes to remind ONC that outside the HIPAA space, voluntarily adopted codes of conduct can be enforced by the Federal Trade Commission, and many of those codes are under development.
Scott Mace, for HealthLeaders Media , June 9, 2015
Patient data, a longitudinal patient record, and patient identifiers remain valid goals of healthcare reform, despite unhappiness with meaningful use.
Last week I spoke with a former CIO who assembled a longitudinal patient record dating back 12 years from seven different healthcare organizations her system didn't own, all of which had agreed to use a single patient ID defined by her system's master-patient index. She made this record accessible via the Web to providers and patients.
This wasn't a recent development. The system went live in 2004 with 700,000 patients.
But then that CIO received a fateful phone call from a patient.
Posted on Jun 08, 2015
By Mike Miliard, Editor
CSC has agreed to settle with the Securities and Exchange Commission to the tune of $190 million, after SEC charged the firm with "manipulating financial results and concealing significant problems" related to its massive IT contract for U.K.’s National Health Service
That contract was part of NHS' since-abandoned National Programme for IT initiative, a disastrously problem-plagued project marked by huge cost overruns, missed deadlines and undelivered promises.
Launched in 2002, the £11 billion initiative was billed as the biggest civilian technology undertaking in the world – a top-down plan to outfit hospitals and health trusts nationwide with electronic health records linked into an interoperable NHS-wide framework.
June 8, 2015 | By Susan D. Hall
With a combination of electronic health records, wireless connectivity, mobile devices and more, healthcare is ready for a solution to alert overload, according to Vitaly Herasevich, an associate professor of anesthesiology and medicine in the department of anesthesiology at the Mayo Clinic. The 2015 edition of the ECRI Institute's top 10 patient safety concerns for healthcare organizations once again named alarm hazards as its No. 1 issue.
It's time for ambient intelligence in the hospital, Herasevich wrote in an article at HIMSS News, who outlines five steps toward that end, including:
- The new generation of alerts can be improved from massive amounts of data already collected in the EHR. Deep understanding of disease and pharmacological effects of treatment are essential to creating smart rules for alerts, he says.
- Ambient systems need to recognize patient treatment processes to deliver alerts to the right person at the right time in the workflow process.
- Real-time feedback to bedside providers is essential, Herasevich says. Alert systems should constantly analyze responses to alerts and adjust accordingly.
- The fourth step in rules development is clinical validation against a gold standard, which requires clinical research similar as the study of new drug, he says.
- Regulatory approval of complex smart rules should be the last, fifth step to ensure efficiency, safety and support any commercial claims.
Health and Social Care Information Centre failed to log requests of up to 700,000 patients not to pass on details and says issue ‘may take some time’ to resolve
Saturday 6 June 2015 10.23 AEST Last modified on Tuesday 9 June 2015 00.26 AEST
The body responsible for releasing NHS patient data to organisations has admitted information about patients has been shared against their wishes, it has emerged.
Requests by up to 700,000 patients for details from their records not to be passed on, registered during preparations for the creation of a giant medical database, have not been met.
But the Health and Social Care Information Centre (HSCIC) told MPs that it “does not currently have the resources or processes to handle such a significant level of objection” and it also encountered technical issues over logging the preferences.
Patients registered their objections during the development of the controversial care data system but the plans were shelved in March 2014.
Monday, June 8, 2015
SAN DIEGO -- San Diego Health Connect, the region's health information exchange, is expected to get a big boost with the addition of the area's three largest health systems.
Scripps Health, Sharp HealthCare and the University of California-San Diego Medical Center join about 100 other facilities already participating in Health Connect, including Rady Children's Hospital San Diego, Kaiser Permanente, the Department of Veterans Affairs and the Department of Defense.
The community-wide HIE -- which allows patient medical records to be shared among the region's competing health care providers -- currently has consent from about 1.5 million patients.
To expedite participation among patients from Scripps, Sharp, UC-San Diego, and other providers, Health Connect and its participating organizations recently adopted a new policy to gain patient authorization. Patients must now opt out of the program, rather than explicitly give consent to participate.
The NHS has confirmed this weekend that ‘hundreds, maybe thousands, probably lots’ of patient records have been passed to third parties against the patients’ wishes. A spokesman said: ‘We couldn’t help it, there was no way we could stop ourselves, and despite our strongest desires we just had to accept payments for this data. We’ll probably have to have a party or pay some bonuses to get rid of it. Maybe we could use it to influence the location of the World Cup?’
Experts are worried that the contagion might spread to other government agencies using the same incompetent computer system suppliers. A MoD spokesman confirmed that most of the Trident Missiles are currently pointing at UK targets, due to payments from Russia. ‘We don’t like it, but cash is cash, and anyway, it’s what the computer says’, he said.