Monday, September 01, 2014

Weekly Australian Health IT Links – 01st September, 2014.

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

The review of the NBN and what will now apparently be delivered, as far as broadband is concerned, to a waiting populace. It is a compromise but seems as though it might just deliver some useful improvement reasonably quickly. As always it seems, time will tell!
Otherwise the consultation period on the PCEHR Review concludes today and now we wait to discover what we all think. Hopefully will only take a few weeks and then the outcomes can become public - in my dreams I fear!
Enjoy the browse.
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FTTP needed for teleHealth, say Labor MPs in open letter

Two Labor members of Parliament have written an open letter to Malcolm Turnbull asking him to reconsider his scrapping of the Coalition’s FTTP NBN plans.
They argue that the greater bandwidth of Labor’s fibre to the premises (FTTP) plan is necessary for the effective provision of teleHealth – using the Internet for remote diagnostics and monitoring and the like.
The letter some two days after the Vertigan panel on the NBN’s cost-effectiveness concluded that an FTTP network would be much less cost-effective than the Coalition’s ‘multi technology mix’ model.
The main criticism of Vertigan’s findings is that its conclusions are made on assumptions about the future value of broadband services, when we cannot put a value on applications we cannot know about. The Vertigan report assumes the Internet will be used much as it is now, while the open letter explores one specific class of new applications - teleHealth
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eHealth NSW gets busy on technology rollouts

CIO Michael Walsh and CCIO John Lambert give an update on the several e-health projects underway
Rebecca Merrett (CIO) on 29 August, 2014 09:00
eHealth NSW CIO, Michael Walsh, and newly appointed chief clinical information officer, John Lambert, have laid out some of the technology projects they are focusing on this year, as part of the state’s $400 million e-health strategy.
At an AIIA event in Sydney this week, Walsh and Lambert gave an update on clinical portal HealtheNet, an enterprise image repository, incident management system, StaffLink HR system , videoconferencing, and how the organisation is increasing bandwidth.
The HealtheNet portal is a Commonwealth funded project that links multiple hospital databases to give clinicians a single view of repositories. It also integrates with the national Personally Controlled Electronic Record (PCEHR).
Walsh said he is currently working with the federal government on integrating pathology reports into the PECHR so that clinicians using HealtheNet do not have to re-do recent reports.
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E-health needs information, not just data: CIO

By Natasha Egan on August 29, 2014 in Government, Technology
Data collected for e-health must be useful information to clinicians and system managers otherwise it is not worth collecting and providing, NSW Health’s chief information officer has told an information industry forum in Sydney this week.
Michael Walsh, who is also the newly-appointed CEO of the government’s two-month old e-health entity, was giving an update on the state’s 10-year $1.5 billion e-health strategy to the Australian Information Industry Association’s state healthcare forum on Wednesday.
Mr Walsh gave a glimpse of the thinking in eHealth NSW’s forthcoming draft strategic plan, which, while originally due in August, would be released later this year for public consultation, he said.
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Telstra says answer to healthcare lies in the cloud

Jessica Gardner
Healthcare companies hoping to tap into growing Asian markets should focus on innovative cost-saving measures that help governments reduce their exposure to ballooning medical care budgets, experts have said.
Telstra’s head of health Shane Solomon told an Asialink Business event in Melbourne that although countries in the region were spending to improve their healthcare offering, companies should not expect an easy windfall based on exporting systems in place in Western economies. “These [Asian] systems are not rich,” he said. “The real disrupter in Asia will be the low-cost solutions.”
Mr Solomon, who was poached from KPMG last year to lead Telstra’s foray into health technology, said countries like Indonesia, where there are 0.6 hospital beds per 1000 people, cannot simply respond by building expensive infrastructure. “[The government is] looking to understand how can the population benefit from the advances in the economy without having to build ­squillions of hospitals,” he said.
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Telstra plans to move into e-health before Asia push

Telstra executive Gordon Ballantyne says the telecommunications giant will use domestic markets as a proving ground for its burgeoning health business before pushing into growth markets in Asia.
Telstra has made a number of investments in start-ups such as pharmacy software provider Fred IT and doctor booking website HealthEngine after announcing, just over a year ago, that it would make a play in the health technology sector.
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J Am Med Inform Assoc doi:10.1136/amiajnl-2014-002804

The double-edged sword of electronic health records: implications for patient disclosure

  1. Celeste Campos-Castillo1,
  2. Denise L Anthony2

Abstract

Objective Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients’ global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure.
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EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.
Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.
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New Online Forums to Support People Living with Mental Illness

Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched by the Minister for Health, Peter Dutton.
Page last updated: 27 August 2014
27 August 2014
Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched in Canberra today by the Minister for Health, Peter Dutton.
Minister Dutton said the SANE Australia Online Forums would help people by giving them trusted and anonymous access to reliable mental health information, advice and referrals.
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Taking care of each other online

| Aug 25, 2014 8:06AM | EMAIL | PRINT
One of the benefits of the Internet is its use as a tool to create communities among people who previously would have been isolated from each other.  Nowhere is this more apparent than in the growth of online forums for people with chronic illnesses and disabilities.  These are playing an increasingly important role in providing information, support and assistance to people with serious and chronic illnesses but they remain an under-researched area of the health system.   Susan Stewart Loane, a PhD Researcher at Macquarie University, is addressing this gap through her research and provides the following report of her findings. She writes:
No one had heard from Tracey[*] for a while, which was a concern because Tracey had Motor Neuron Disease (MND).  Members of Tracey’s social circle tried valiantly to contact her with no success.  Finally, someone decided to drive 250km to her house and check that she was ok.  She was.  She’d had a fall and was too dizzy to use the computer.  The friend got the message out and everyone was relieved.  But a week later Tracey still hadn’t got in touch and they started to worry again.  Someone who lived closer (but who barely knew Tracey) offered to drive to her house and check on her.  Again Tracey was found to be ok, but still recovering.
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Department of Human Services uses big data analytics to measure staff performance

DHS health and information deputy secretary Barry Sandison says call centre staff are measured on how quickly they answer the phone
Hamish Barwick (CIO) on 26 August, 2014 09:52
The Department of Human Services (DHS) is striving to improve its customer service through the use of big data analytics.
Speaking at the Teradata Summit in Sydney, DHS health and information deputy secretary Barry Sandison told delegates that it has a “gigantic database” of customer behaviour information.
“Every Australian is in the database and we divide our data sets into child support, Centrelink and Medicare. There are 23.5 million active records,” he said.
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Pharmacy project stops drug misuse

By ARYELLE SARGENT
Aug. 26, 2014, 3:33 p.m.
BEFORE a program called Project STOP, people could walk into a pharmacy off the street and purchase cold and flu tablets for the pseudoephedrine to make ice.
Pharmacy Guild of Australia state president and Coventry Pharmacy Latrobe pharmacist John Dowling said customers looking to make the drug would go to several pharmacies to buy enough tablets to avoid suspicion.
Project STOP has nipped this in the bud with a national database that records who buys cold and flu tablets containing pseudoephedrine.
This requires those buying the tablets to show a valid drivers’ licence.
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How Medibank embraced cloud, overcame shadow IT

Medibank enterprise security manager Mark Burns says it has embraced the cloud rather than trying to stop staff using services
Hamish Barwick (Computerworld) on 27 August, 2014 11:09
Medibank is allowing staff outside of the IT department to sign up to cloud services such as Amazon Web Services (AWS) to reduce website hosting costs, while at the same time including IT security in the process, according to Medibank enterprise security manager Mark Burns.
Speaking at the Gartner Security and Risk Management Summit in Sydney this week, Burns told delegates that IT security has received 20 separate requests over the past six months to use different cloud services such as online storage.
“One of the key challenges for my security team is dealing with the potential loss of visibility. Traditionally, we were able to force the business to engage with IT because they were relying on us to deploy the server, install the software or open up the firewall,” he said.
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DHS to roll out network ‘stress testing’ for agencies

Department of Human Service's data centre environment has become more complex following integration of other agencies in mid-2011
Byron Connolly (CIO) on 28 August, 2014 11:24
The Department of Human Services (DHS) has tendered for testing and network infrastructure to benchmark and validate changes to its data centre to support the integration of Centrelink, Medicare and CRS Australia.
These agencies were rolled into one DHS portfolio in mid-2011, which has increased the scale and complexity of its data centre environment.
In February last year, DHS told CIO it was hoping to cut the number of system outages across its environment by 5 per cent per quarter until early 2014. The agency experienced 137 system reliability outages in the 12 months between October 1, 2011 and September 30, 2012.
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The many tribes of informatics

August 29, 2014
My learned and senior informatics colleagues spend much time debating the different professional roles that together are needed to support the practice of informatics (e.g. informatician, informatasist). Over the years I have assembled a set of definitions for these professional roles, as well as allied concepts. I feel this list is unlikely to help the debate at all.
Informatocyst [In-for-mata-s-ist, n] (see also, legacy system). A collection or build up of information, walled off from the greater information system by a barrier of incompatible or aged interchange standards.
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Paging Dr. Watson, IBM's medical adviser for the future

IBM's Watson could help doctors by analyzing the masses of literature in the field
Joab Jackson (IDG News Service) on 29 August, 2014 07:39
IBM Watson can match possible treatments to genetic disorders
IBM continues to make the case for the nascent field of cognitive computing, showing off some Watson prototypes Thursday that could help speed scientific discovery in the medical field, by scanning large volumes of literature and data far more quickly then humans can, and suggesting possible leads.
The New York event was to promote an update to a cloud service, called Watson Discovery Advisor, that can help researchers find fresh connections within mass realms of data.
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Diagnostic software may detect cancer in X-rays

  • Elizabeth Dwoskin
  • The Wall Street Journal
  • August 26, 2014 12:00AM
WHAT if software akin to the program that recognises faces in Facebook photos could detect cancer in an X-ray?
That’s the idea behind Enlitic, a new US startup founded by Jeremy Howard, who is a heavy hitter in big data — he’s data strategist for Silicon Valley venture capital powerhouse Khosla Ventures and former president and chief scientist of Kaggle, which hosts big-brain predictive modeling competitions.
Enlitic aims to use advances in machine learning to make medical diagnoses.
The company says it has partnered with hospitals and medical imaging companies — Howard won’t say which ones — to mine a host of data sources, including X-rays, lab results, handwritten doctors notes, and claims records. The company is building software algorithms to identify otherwise invisible patterns in these data sources, making for sharper diagnoses.
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Thatcher reflects on ten years at Mater

Longstanding Mater Heath Services chief information officer, Mal Thatcher is set to move to the new strategically focused Chief Health Information Officer role at Queensland Health. The move, which involves a 12 month leave of absence from Mater, is set to commence next month.
While Thatcher was circumspect about what his placement will involve at Queensland Health – he said he was waiting until he hit the ground – he was willing to look back over his decade plus time at Mater.
“I have two roles at Mater,” he said. “I am chief information officer, and also executive director for information and infrastructure.”
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Australian startup snapshot: Vimcore

Connecting business employees to healthcare providers
Adam Bender (Techworld Australia) on 29 August, 2014 16:06
Vimcore is a Sydney B2B startup that connects its customers’ employees to local healthcare providers. When not running the business, the company’s co-founder, Jessica Evans, advocates women entrepreneurship in the largely male tech startup scene.

The pitch

Vimcore targets businesses that care about employee health and want to provide a simple way for their staff to access healthcare advice and find medical services.
Evans, a physiotherapist, has experience in the corporate world, including a previous job at Sanitarium. She said she has seen first-hand that large companies often struggle to provide good healthcare information and services to employees.
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CDA Validator v2.0 and Template Packages Available for Download

Created on Thursday, 28 August 2014
NEHTA has released the next major version of its CDA Validator tool for the automated validation of clinical documents. This new version helps implementers reduce development and test times by performing a wider range of checks for clinical documents.
Version 2.0 of the CDA Validator now covers validation of:
  • The CDA document itself;
  • The CDA package containing the CDA document, attachments and additional material;
  • Updated versions of clinical terminology.
The validation of CDA documents can now be performed against different versions of clinical document specifications. This is supported by the publication of all available template packages for these specification versions on the NEHTA website. CDA Validator v2.0 can perform CDA document validation against any of these template packages.
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Astounding finding - NBN benefit not worth cost

The long awaited Vertigan cost benefit analysis of the NBN has found that Labor’s version was a waste of money, while the Coalition’s offers much better value. Wow!
One of the main criticisms Malcolm Turnbull and the Coalition levelled against Labor’s FTTP (fibre to the premises) NBN was that no cost benefit analysis (CBA) was ever conducted.
Now, as part of the Government’s never ending NBN review process, we have such a CBA. It finds that Labor’s FTTP NBN provides much worse value for money than the Coalition’s ‘multi technology mix’ (MTM) NBN. The unsurprising finding is based on a number of assumptions that unfortunately do little to dispel the view that the report’s conclusions are tailor-made to suit the Coalition’s purposes.
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NBN cost-benefit analysis signals the end of an era

The long-awaited cost-benefit analysis of the National Broadband Network suggests the days of politicians shooting from the hip with taxpayer dollars are numbered.
The long-awaited cost-benefit analysis of the National Broadband Network suggests the days of politicians shooting from the hip with taxpayer dollars are numbered.
As Labor’s NBN unfolds amid reviews and revelations, it’s apparent the NBN was a political move based on romantic notions of policy-making ending in Labor’s electoral defeat in 2013.
In government, the Coalition called for a strategic review of the NBN, revealing a number of problems with the project’s implementation. Malcolm Turnbull also promised to deliver an independent cost-benefit analysis of the economic and social costs and benefits of the NBN.
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Cost benefit analysis shows Turnbull plan has $16b advantage

Date August 27, 2014 - 11:00AM

Matthew Knott, Peter Martin

The Abbott government's pared-back broadband plan is three times more cost effective than Labor's ambitious scheme and would leave Australians $16 billion better off, according to the first independent cost-benefit analysis of the national broadband network.
In a scathing verdict on the Rudd and Gillard governments' plan to introduce fibre directly to 93 per cent of premises, the cost benefit analysis finds the policy is so expensive it would barely leave the community any better off in net terms than if broadband investment remained frozen at present levels.
The much-anticipated report finds households and businesses will benefit from quicker downloads but the much-vaunted societal benefits of fast broadband – such as improvements to health and education services – will probably be extremely limited.
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Government low-balling us on second-rate NBN

Date August 29, 2014 - 11:52AM

Gadgets on the go

Adam Turner is an award-winning Australian freelance technology journalist with a passion for gadgets and the "digital lounge room".

Justifications for the multi-technology mix only add up when you ignore the inconvenient numbers.
This week's NBN review supports the government's decision to scrap the national fibre-to-the-premises rollout and instead take a patchwork multi-technology mix approach – hooking up a quarter of homes to fibre but relegating the rest to HFC cable, fibre-to-the-node or satellite. It's telling that Communications Minister, Malcolm Turnbull, was happy to sign off on this approach before the report was completed, after criticising Labor for favouring fibre-to-the-premises without first crunching the numbers.
If you're still not convinced that the NBN-lite is a bargain, Turnbull is happy to spell it out for you on a whiteboard – explaining why fibre-to-the-node is more cost-effective than fibre-to-the-premises. The always articulate Turnbull makes some valid points, but the numbers only stack up if you assume low growth in bandwidth demand, ignore the costs in maintaining legacy infrstructure and don't factor in the possibility of future fibre upgrades.
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High-speed broadband can quickly be delivered at a reasonable cost

Henry Ergas

THAT the release of the cost-benefit analysis of the National Broadband Network has generated as much heat as light is perhaps unsurprising. The debate about the NBN has always been drenched in politics. And the analysis itself is lengthy and complex, making its findings difficult to communicate and absorb.
But every voter needs to understand what is at stake in Australia’s biggest infrastructure project. So here is “an intelligent reader’s guide to the NBN CBA”.
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Explainer: Which NBN scheme is best for you?

Date August 31, 2014 - 9:00AM

Peter Martin

Economics Editor, The Age

It was going to be bigger than the Snowy Mountains Scheme and it was going to revolutionise our lives. Four years ago Labor began an audacious program of connecting every house and business in the country to the internet, all over again. It was to cost $43 billion and it commenced without a cost benefit analysis. This week the Coalition released the results of a cost benefit analysis into Labor's NBN, the first. It finds the benefits would never have approached the cost. Who's right, and who's offering the best plan now? Peter Martin runs the numbers.
WHAT WAS LABOR OFFERING?
Every address in every city and reasonable sized town was to be offered the chance to be wired up to an optical fibre cable. Remote locations were to be connected by satellite and wireless. As of June this year NBN Co had connected 210,000 locations and had millions to go. The promised speed for the fibre links was 100 megabits per second, with the whole system upgradable later to 1000 Mbps, each far faster anything that was available at the time.
WHAT COULD IT BE USED FOR?
The cost benefit study finds most uses don't require anything like 100 Mbps. Ultra high definition TV comes closest. The government's advertising stressed instead the unknowable nature of its uses saying the NBN would be used "in ways we only dream of".
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DIY blood pressure better than doctor, study finds

  • AP
  • August 27, 2014 7:27AM
 “DO-IT-YOURSELF” blood pressure measurements and medicine changes work better than usual doctor-office care in some patients, a study of older adults in England found.
Those who did their own readings at home and adjusted their medicine as needed had healthier blood pressure levels after a year than those who got standard doctors’ care.
Self-care patients weren’t completely on their own — any changes they made were part of a treatment plan previously OK’d by their doctors. But the patients didn’t need to consult their doctors every time they increased the dose if it was part of the original treatment plan.
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Enjoy!
David.

Sunday, August 31, 2014

So What Happens Next Now The Consultation On The PCEHR Review Has Finished?

Regular readers will be aware that over approximately the last 2 months Deloitte has been assisting DoH in consulting stakeholders on the PCEHR as produced by the Royle Committee the report of which was released in May.
There is a link discussing all this here:
About a month ago we had the astonishingly botched release of an online survey for the public and others (vendors and clinicians) to respond to. You can read about all that here:
and here:
There was also an article I published a month ago pointing out that the options for the PCEHR Review were pretty limited. See here:
Finally we have had a leak of a NEHTA Report dated June 2014 which basically said most GPs who were surveyed and were PCEHR enabled were basically not at all impressed and were not using the system.
Internally we know that present Government E-Health leadership are in denial on the usability and utility of the PCEHR and really seem, for some evidence free reasons, to think that the thing should rumble on.
We also know that many stakeholders (RACGP, Software Providers, many academics etc.) are aware there are major problems with the whole program and have been providing feedback to that effect, as I have been. See here:
So what happens next? It seems to me there are three basic options.
Option 1. - Abandon the whole PCEHR program and move back to a progressive funded implementation of a revised National E-Health Strategy with a collaborative approach with the private sector - accepting National Programs need to develop from the ground up and not top down.
Option 2. - Decide to announce consultation on a National E-Health Strategy Refresh and defer consideration on the fate of the PCEHR until the Strategy is developed, agreed and funded.
Option 3. - The Ostrich Option - pretend all is well and just continue with what is presently happening and going no-where.
I would be OK with Options 1 or 2 but fear we will get Option 3!
David.

AusHealthIT Poll Number 233 – Results – 31st August, 2014.

Here are the results of the poll.

Do You Believe The NEHTA Leadership Should Be Held Accountable For The Slow Progress In E-Health Over Almost The Last Decade?


For Sure 48% (79)

Possibly 34% (56)

Neutral 6% (10)

Probably Not 5% (8)

No Way 4% (7)

I Have No Idea 2% (3)

Total votes: 163

This is a clear cut outcome. The readers of this blog largely believe NEHTA has failed and needs major change.

Again, many, many thanks to the many that voted!

David.

Saturday, August 30, 2014

Weekly Overseas Health IT Links - 30th August, 2014.

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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New Technology Gives Surgeons Unprecedented Views of Patients’ Bodies

by George Putic
When could a video game possibly save your life?  A new imaging technology, now being used at Methodist Hospital in Houston, Texas,  has direct links to video games.  It can provide detailed views of patients’ bodies -- helping surgeons plan and execute complicated operations with much more confidence. 
Those who think that developing video games software has no other purpose than entertainment should think again.  
So says Dr. Brian Butler, a radiation oncologist at Houston Methodist hospital and the principal author of a new imaging technology called Plato’s CAVE. “Computer engineers and video gamers -- really propelled this type of technology into a possibility,” he said.
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Is 4D printing next for healthcare?

Posted on Aug 22, 2014
By Mike Miliard, Managing Editor
The healthcare industry will be among the first to reap the benefits of emerging four-dimensional printing technology, according to a new report from Frost & Sullivan.
4D printing develops chameleonic materials whose properties shift according to external stimuli, such as temperature changes.
As MIT research scientist Skylar Tibbits described it in a TED talk, the technology "will allow us to print objects that then reshape themselves or self-assemble over time. Think: a printed cube that folds before your eyes, or a printed pipe able to sense the need to expand or contract."
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6 success factors for HIE participation by a health system

August 22, 2014 | By Dan Bowman
The participation of health system leadership and timely and accurate communication are among the biggest factors contributing to the success of hospital participation in a health information exchange, according to research published this month in the Journal of Medical Internet Research – Medical Informatics.
Through a combination of interviews, data analysis and direct observation, the researchers--from the University of South Carolina and Claremont Graduate University in Claremont, California--pinpoint six factors for success in examining the implementation of Falls Church, Virginia-based Inova Health System into the ConnectVirginia EXCHANGE, the state's HIE.
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Health IT vendors among fastest growing

Posted on Aug 22, 2014
By Erin McCann, Associate Editor
Health IT companies once again made it to the list of fastest growing companies this year, with three big name EHR vendors chief among them. 
Inc., which on Thursday released its hallmark annual list of private America's 5,000 fastest growing companies, found 377 -- or 8 percent -- to be healthcare related; despite the low percent, however, the sector accounted for the lion's share of revenue ahead of all industries at $21.8 billion. What's more, within the sectors, it's a tech dominated list, with health IT companies faring quite well. 
Among the fastest growing were three recognized EHR platform companies: CareCloud; drchrono and eClinicalWorks, which ranked 127th, 249th and 4064th respectively. Both CareCloud and drchrono are new to this year's list.
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Study: Many patients don’t understand electronic lab results

Author Name Jennifer Bresnick   |   Date August 21, 2014   |  
More and more patients may be accessing their personal health information online through patient portals thanks to Stage 2 of meaningful use, but only slightly more than half of patients, on average, were able to decipher electronic lab test results on their own, says a study from the University of Michigan.  Patients who scored on the lower end of numerical and health literacy tests were twice as likely to express confusion when shown a hypothetical blood glucose test result, said study author Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health.
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Apple steps up Health push as it begins talks with insurers

Summary: With Apple's new Health app set to launch this year, the company has been in discussions with insurance companies about where it could fit into their business.
By Liam Tung | August 22, 2014 -- 10:46 GMT (20:46 AEST)
Apple has been in talks with US health insurance firms, it has emerged - notably those that have already taken steps to integrate data from wearables into insurance policies.
Apple has been preparing the ground for the launch of its Health application, which will debut alongside iOS 8 later this year. Besides recent talks with US healthcare providers and developers of health-related apps, Apple has also been courting large US health insurance firms.
News of Apple's discussions with health insurers came via an interesting report from Bloomberg today on the emergence of company-funded wearables in the workplace. The report notes that Apple has talked with America’s biggest insurer, UnitedHealth, as well as fellow health insurer Humana.
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Microsoft taps into mHealth

Posted on Aug 21, 2014
By Erin McCann, Associate Editor
With nearly 26 million Americans living with diabetes -- and racking up $245 billion in costs each year -- many stakeholders have been looking for innovative ways to help those individuals better keep tabs on their condition. With its new mobile health project, Microsoft is the latest company to offer a diabetes management platform.
Microsoft on Thursday announced it was inking a deal with wireless provider TracFone to extend mHealth technology to underserved and high-risk populations, specifically aimed at patients living with diabetes. 
The two companies have teamed up with Miami-based Health Choice Network to launch a pilot program aimed at examining how access to mobile technology affects patient disease-management and outcomes. 
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Computer bug 'Heartbleed' likely source of Community Health Systems data breach

August 21, 2014 | By Katie Dvorak
Hackers likely used the computer bug Heartbleed to gain access to the data of about 4.5 million patients at Community Health Systems--and the FBI is warning other hospitals they could be at risk too, Reuters reports.
The hack at CHS is the first known large-scale cyberattack using the bug, which compromises the Web encryption program OpenSSL, opening hundreds of thousands of websites to data theft. 
During this morning's monthly cyber threat briefing, broadcast online, HITRUST CEO Dan Nutkis spoke about the need for greater dissemination of information when breaches like this happen.
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90% of hospitals and clinics lose their patients' data

By Jose Pagliery  @Jose_Pagliery August 20, 2014: 11:06 AM ET

No industry has been hit harder by hacking and data breaches than health care.

Recent numbers show 90% of health care organizations have exposed their patients' data -- or had it stolen -- in 2012 and 2013, according to privacy researchers at the Ponemon Institute.
The medical industry faces more breaches than the military and banking sectors combined.
As of last week, the medical industry has been slammed with 204 incidents this year, nearly half of the major breaches so far. It has lost 2.1 million records. And that doesn't even count the 4.5 million names and Social Security numbers taken from Community Health Systems' computer network in a major hack that was revealed on Monday.
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New Tool Predicts Public Health Policy Impact

AUG 20, 2014 10:16am ET
HealthPartners Institute for Education and Research, Partnership for Prevention, and the Robert Wood Johnson Foundation have launched a web-based tool that predicts the health and economic impact of evidence-based public health interventions and policies at the county level.
The tool, called Community Health Advisor, enables public health officials, employers, community leaders, policymakers and others to more accurately determine which public health policies and programs will have the greatest impact on health, mortality and medical costs on a county, state or national level.
“This tool is the first to provide estimates of future health outcomes and medical costs from public health interventions for every county in the country,” said George Isham, M.D., senior adviser, HealthPartners, and member of the National Commission on Prevention Priorities. “It helps lawmakers, community leaders, employers and others make informed decisions about where to make public health investments.”
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EHRs Behind Bars: Progress and Barriers

by Heather Drost, iHealthBeat Associate Editor Thursday, August 21, 2014
Although electronic health records are widely seen as a way to improve care coordination and boost patient outcomes, they are underutilized in the treatment of some of the individuals who stand to benefit the most: jail inmates.

Background on Inmate Health Care

The nation's more than 3,300 county, city and local jails process about 11 million admissions annually. Jail populations are highly mobile, with an average weekly turnover of 60%, and are largely uninsured with high rates of chronic diseases, mental illness and substance misuse.
Since the 1976 Supreme Court decision in Estelle v. Gamble, jails have been legally required to meet the medical needs of inmates in accordance with community standards of care. Jails that fail to meet those needs could be held in violation of the Eighth Amendment prohibition against cruel and unusual punishment.
However, jails historically have not been recognized as providers of health care and tend to be left out of major policy discussions, such as the 2009 passage of the HITECH Act, which created the meaningful use electronic health record incentive payment programs.
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CA Powers Up $80M HIE to 'Create Value in the Data'

Christopher Cheney, for HealthLeaders Media , August 21, 2014

California's latest multimillion-dollar attempt to build a statewide health information exchange aims to shave healthcare costs and improve care, but its leaders face a long-term funding challenge.

This month's launch of an ambitious statewide health information exchange in California poses an $80 million challenge to the project's organizers: sustaining an HIE over the long haul.
Blue Shield of California and Anthem Blue Cross are picking up the $80 million tab for Cal INDEX during its first three years of operation. After the seed money has been depleted, subscription fees are expected to keep Cal INDEX finances in the black.
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The 4 Biggest Obstacles ACOs Face

8/14/2014 @ 12:59PM

In a recent interview, business guru and best-selling author Clayton Christensen described American health care as “sick and getting sicker.”
He criticized the system’s administrative overhead, perverse payment models and lack of leadership for failing to incite meaningful reform.
Christensen thrives on examining complex topics. So, when I asked him what topic he’d like me to cover, he picked one that’s as complex as they come: Accountable Care Organizations (ACOs).
“A lot of the thinking behind the Affordable Care Act, how it can improve quality while lowering cost, relies heavily on ACOs,” Christensen said. “Most health care players would say that ACOs have helped. I’d argue they’re not yet fixing the problems.”
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Meaningful use medication measures reduce ADEs by 35%

Author Name Jennifer Bresnick   |   Date August 18, 2014   |  
Hospitals that adopt all five of the core medication management measures inherent in meaningful use experience fewer adverse drug events (ADEs), says a new study funded by the Agency for Healthcare Research and Quality, reducing the number of patient safety errors by more than one third.  The use of computerized provider order entry (CPOE) technology, decision support systems that check for drug and allergy interactions, and health information exchange that encourages the sharing of medication lists and allergy information with other providers were key features associated with the significant improvement in the rate of ADEs, explain John White, MD and Judy Murphy, RN, Director of the Office of Clinical Quality and Safety and Chief Nursing Officer at the ONC.
“When the Health Information Technology for Economic and Digital Health (HITECH) Act was passed in 2009 as part of the American Recovery and Reinvestment Act, hopes were high that widespread use of electronic health records (EHRs) would reduce the rate of adverse drug events in hospitals,” Murphy and White write in a blog post for HealthIT Buzz.  “Advocates believed incentives that encouraged hospitals and physicians to adopt EHRs would not only encourage faster adoption, but help to improve patient health.”
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Is the Electronic Health Record Defunct?

by Jerome Carter on April 28, 2014 ·
When building software, requirements are everything. And although good requirements do not necessarily lead to good software, poor requirements never do.   So how does this apply to electronic health records?   Electronic health records are defined primarily as repositories or archives of patient data. However, in the era of meaningful use, patient-centered medical homes, and accountable care organizations, patient data repositories are not sufficient to meet the complex care support needs of clinical professionals.   The requirements that gave birth to modern EHR systems are for building electronic patient data stores, not complex clinical care support systems–we are using the wrong requirements.
Two years ago, as I was progressing in my exploration of workflow management, it became clear that current EHR system designs are data-centric and not care or process-centric. I bemoaned this fact in the post From Data to Data + Processes: A Different Way of Thinking about EHR Software Design.   Here is an excerpt.
Do perceptions of what constitutes an electronic health record affect software design?  Until recently, I hadn’t given much thought to this question.   However, as I have spent more time considering implementation issues and their relationship to software architecture and design, I have come to see this as an important, even fundamental, question.
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mHealth takes on diabetes

Posted on Aug 20, 2014
By Eric Wicklund, Editor, mHealthNews
Boston's Joslin Diabetes Center is using an mHealth platform to help diabetics and their caregivers control a potentially fatal side-effect of the disease.
Joslin and Glooko have launched the HypoMap, a mobile tool that enables diabetics and their caregivers to identify low blood-sugar readings, or hypoglycemia. If left untreated, the condition can plunge the diabetic into a coma and even lead to death. It’s especially dangerous for a percentage of the world's diabetics who can't recognize the symptoms associated with hypoglycemia – a condition known as hypoglycemia unawareness – and therefore don't recognize the danger signs.
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Sharing electronic records with patients gains traction, raises new concerns

August 19, 2014 | By Marla Durben Hirsch
More hospitals and physicians are choosing to provide their patients with access to their electronic records, but the practice is also raising new controversies, according to a recent article on National Public Radio.
In the article, Leana Wen, director of patient-centered care research in the department of emergency medicine at George Washington University, points out that sharing notes with patients has been a positive experience, enabling her to correct errors caught by patients' review of the records and providing information that helps her diagnose conditions more quickly. The access also increases trust.
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Physician groups call for EHR education in med school

Written by Helen Gregg (Twitter | Google+)  | August 18, 2014
The American Osteopathic Association has become the latest physician group to advocate for EHR training to be a part of medical students' education.
During its annual House of Delegates meeting in July, the AOA approved a resolution to work with the American Association of Colleges of Osteopathic Medicine and the American Osteopathic Association of Medical Informatics to increase opportunities for medical students to practice working with EHRs.
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AHA releases cybersecurity resource for hospital boards

Written by Akanksha Jayanthi (Twitter | Google+)  | August 19, 2014
The American Hospital Association has issued a new guide reviewing the role of hospital and health system boards in cybersecurity risk management and response.
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HIEs and interoperability: 6 statistics on quality, efficiency

Written by Akanksha Jayanthi (Twitter | Google+)  | August 19, 2014
The majority of physicians who electronically exchange data report health information exchanges are overall beneficial to their practice. However, physicians also often experience barriers to data sharing capability implementation.
Here are six statistics on the quality and efficiency of HIEs and interoperability, reported in the ONC's National Health Information Exchange and Interoperability Landscape report.
1. One-quarter of providers reported HIEs increase the practice's liability due to other providers lacking adequate privacy and/or security safeguards.
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Every EHR's weakest link

When asked to rate the security of typical electronic health records, SANS Institute senior analyst John Pescatore answered: 9.
At first blush that might even seem positive, but in the world of IT and information security where the phrase “five 9’s” — in this case meaning 99.999 percent secure — indicates the highest level of protection, a simple 9 leaves plenty to be desired.
And with stolen health information commanding ever-higher prices on the black market, criminals growing more and more sophisticated, and the complex nature of EHRs themselves, it’s time to better understand the problem.
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Snooping staff still top security issue

Posted on Aug 19, 2014
By Erin McCann, Associate Editor
When it comes to data breaches, hacking and loss or theft of unencrypted devices are far from healthcare security professionals' only concerns. Employee snooping and insider misuse also prove to be among the biggest privacy threats in the healthcare sector today.  
Just last week, a former Tufts Health Plan employee was convicted of disclosing patient information in a fraudulent tax refund scheme after stealing the personal data of more than 8,700 members. The former employee, Emeline Lubin, started working at Tufts Health Plan in Watertown, Mass., back in 2010. For that time, Lubin sent lists of member data to a Florida man in efforts to file false income tax returns. Lubin could face up to five years in prison and a $250,000 fine. 
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On the buses

In the latest of EHI’s series on information sharing initiatives, Rebecca Todd reports on the Oxfordshire Care Summary.
12 August 2014
The Oxfordshire Care Summary is an unusual information sharing initiative because it was created by a hospital IT team and is hosted in an acute environment.
Similar initiatives in other parts of the country have been created by shared IT services with a focus on primary care, because their aim has been to share GP information with other parts of the system, or to create entirely new records to work across health and social care.
The OCS, by contrast, is hosted on Oxford University Hospitals’ ‘case notes’, a clinical intranet that GPs have been able to use for 20 years to access pathology results and some other data.
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Another view of savings

GP Neil Paul says some clear thinking is needed about where IT can be used to meet patient demand and save the NHS money, and where it will make things worse; but a couple of real cases show the difference pretty clearly.
19 August 2014
I keep thinking about the concept of ‘failure demand’. Invented by John Seddon, it’s a concept that says that service industries often fail their customers by making them follow pointless processes, instead of just dealing with what they want or need. 
Often this occurs during some attempt to outsource or restructure for efficiency reasons. The problems it leads to include: a tendency to produce much more activity than was expected, thereby failing to save on costs; and making customers unhappy, thereby losing good will and reputation.
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Records access may reduce GP pressures

19 August 2014   Lyn Whitfield
Giving patients access to their GP records can reduce demand for traditional appointments and telephone calls to practices, a research study has suggested.
The government has set a target of giving all patients who want it access to their GP record – or the elements included in the Summary Care Record - by 2015.
But in a forward to the study by Caroline Fitton, published in the London Journal of Primary Care, Brian Fisher, a GP in Lewisham, says “many practitioners worry that their workload will increase as a result”.
He says GPs worry that patients “will not understand what they read”, leading to more demand for appointments.
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Why 'prevention security' isn't enough in healthcare

August 19, 2014 | By Katie Dvorak
Data security is one of the healthcare industry's biggest obstacles, and the key to addressing that is understanding and identifying areas of risk, says Blair Smith, Ph.D., dean of Informatics-Management-Technology at American Sentinel University.
Smith, in an interview with HealthITSecurity.com, says some of the places where risk is highest in health IT include the practice of "bring your own devices" and cloud security. Mobile devices pose serious concerns for security personnel, he says, as more hackers and outside threats bring exposure and risks to organizations.
Just this week one of the biggest cyberattacks on a healthcare organization was announced. Community Health Systems is facing a breach in which the data of 4.5 million patients was compromised.
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CFO Exchange: Smartphones Poised to Disrupt Healthcare, Says Topol

Scott Mace, for HealthLeaders Media , August 19, 2014

The democratization of medicine is as close as the phone in your pocket, says Eric Topol, MD. Healthcare leaders had better be ready for empowered consumers, cost-cutting mobile apps, and genetic sequencing, which promises to be a differentiator.

You're carrying the key to healthcare's salvation in your pocket.
That was the message from Eric Topol, MD, keynote speaker at last week's HealthLeaders CFO Exchange. In a one-hour tour-de-force session, he made his case for the many virtues of smartphones as constant healthcare companions, patient empowerment, and disruption to the way healthcare has been practiced as far back as ancient Egypt when doctors were also priests.
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Survey: Healthcare lagging in information governance

August 18, 2014 | By Susan D. Hall
Healthcare organizations must improve their information governance (IG) practices, which are an "undeniable imperative," according to an American Health Information Management Association (AHIMA) white paper.
In the survey of 1,000 healthcare professionals, conducted in in partnership with records-management consultants Cohasset Associates, 35 percent of respondents did not know whether their organization had any information governance efforts underway or did not recognize a need for them.
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Community Health Systems hack compromises info for 4.5 million patients

August 18, 2014 | By Katie Dvorak
Personal information for about 4.5 million patients of Franklin, Tennessee-based Community Health Systems--which operates 206 hopsitals in 29 states--was compromised in April and June when hackers gained access to its computer network.
The data included patient names, addresses, birth dates and Social Security numbers, according to a Wall Street Journal article. The data did not include medical or credit card information.
CHS, in an Aug. 18 filing with the U.S. Securities and Exchange Commission, said they believe the attack was the work of a group originating in China. The hackers were able to bypass the health system's security measures to copy and transfer data outside of the company.
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New health apps, games reward patients who take their meds

By Christina Farr and Malathi Nayak
SAN FRANCISCO Thu Aug 14, 2014 7:59pm EDT
 (Reuters) - A group of ex-gaming industry executives say they can use their design chops to solve a major health challenge: Sick patients neglecting to take their medication and costing employers and insurance providers billions of dollars.
Jason Oberfest began thinking about applying game design tricks to complex medical problems in 2011, while at mobile game company ngmoco.
Oberfest built the app to engage users in their health, but he maintained some of the most viral aspects of mobile games, such as gifts, and a feature to see how friends are faring in their treatment. The app also includes a drug database and sends refill alerts to patients.
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ONC highlights EHR adoption by community health centers

Author Name Kyle Murphy, PhD   |   Date August 15, 2014   |  
The Office of the National Coordinator for Health Information Technology (ONC) is looking to the progress made by community health centers whose adoption of EHR technology is nearing 90 percent as any indicator of significant improvements to delivering high-quality care to patients.
In a post on Health IT Buzz, Kerry Souza, ScD, MPH, and Michael Wittie, MPH, highlight data released by the Health Resources and Services Administration (HRSA). According to the recently publishing 2013 data, more than 1,200 national program grantees are providing care to 21.7 million patients.
A total of 87.8 percent of these federally funded health centers are using EHR systems and an even 54 percent are operating patient-centered medical homes (PCMHs). Although the percentage of PCMHs remains unchanged since 2012, the corresponding number for EHR adoption has increased by nearly ten percentage points in one year, up from 79.3 percent in 2012.
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Link All-Payer Claims Databases With Other Data To Boost Transparency

by Virginia Long and David Mould Monday, August 18, 2014
All-payer claims databases -- which already are in place in several states and are about to be implemented in many more -- are intended to make provider and hospital costs more transparent. APCDs include claims data for medical, mental health, pharmacy and dental procedures across providers. Access to these data enables analysis that can help make important comparisons, such as price for services or performance of physicians or hospitals across a state. Thus, APCDs can provide powerful and illuminating information, from tracking state health care spending to guiding patient/consumer choices.
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Hospitals must help patients access digital records — or else

By Ben Sutherly The Columbus Dispatch  •  Sunday August 17, 2014 6:39 AM
The digitization of health-care records has long been heralded as the cure for familiar headaches that afflict patients and their families.
No more hassles in getting medical records from your elderly father’s hospital stay transferred to the nursing home where he’ll recuperate. No more waiting to find out the result of that Pap smear; just go online and avoid playing phone tag with your doctor’s office.
But a new study in the journal Health Affairs found that some of the digital health capabilities that consumers are most likely to notice or find useful are among the biggest digital challenges for hospitals.
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Enjoy!
David.