As millennials grow older and need to make decisions about healthcare services, it’s important for your hospital to understand their attitudes toward their health and how they best communicate so you can reach them on their level and treat them effectively.

Making headlines are more and more ransomware attacks on healthcare providers - including one on Grays Harbor Community Hospital and its medical group involving a $1 million ransom demand. Also in the news week after week are reports on additional organizations affected by the mega-breach at American Medical Collection Agency - a debt collector vendor (until recently, anyway) for many of the country’s largest medical laboratories.

For patients, healthcare providers, and health plans (among other stakeholders) who need trustworthy, actionable information, the advantages of validated “healthcare directories” are wide ranging and will play an increasing part in our nation’s interoperability infrastructure. Healthcare directories play a critical role in enabling identification of individual providers and provider organizations, as well as characteristics about them, their relationships, and the means by which to access and exchange health information among them electronically. Healthcare directories support a variety of use cases, including: electronic endpoint discovery, referrals and transitions of care, health plan enrollment, provider selection, and provider credentialing and privileging.

ONC convened a workshop June 13-14 for stakeholders interested in healthcare directories. This year’s event (a follow-up to one held in 2016) served as an opportunity to reflect on progress and dive deeper into what’s still needed to enhance interoperability in the years ahead. Since our last workshop, the community at large has worked within Health Level 7 (HL7®) to develop a Fast Healthcare Interoperability Resources (FHIR®)-based standard called the Validated Healthcare Directory Implementation Guide (VhDir IG). This standard is capable of supporting a broad range of directory uses to address clinician burden, redundant processes, and quality improvement.

When Hurricane Harvey hit Houston in 2017, some hospitals were effectively turned into islands, cut off from the rest of the city by floodwaters that covered low-lying roadways. As a result, many physicians were unable to drive to the hospitals where they worked, leaving patients to rely on whoever happened to be on duty when the waters rose.

Luckily, Access Physicians, a group that provides acute telemedicine care to hospitals around the country, was already working with a number of facilities in the area — including some smaller healthcare centers that had no physicians at all onsite at the time of the storm. During regular operations, Access Physicians typically provides specialty care. But in the wake of Harvey, the organization’s remote doctors assumed responsibility for the day-to-day duties of the hospitals’ regular physicians.

Two healthcare CIOs and one deputy CISO offer their expert advice to their peers, explaining how to ensure security is wrapped up tight when working with public clouds. Healthcare provider organizations are beyond the initial security fears when it comes to moving systems and data to a public cloud. There exists now a comfort level that simply wasn’t there even a few years ago.

But healthcare CIOs and CISOs still need to be quite prepared when it comes to using a public cloud. While public cloud operators have taken extraordinary steps when it comes to security, hospitals and health systems still have a job to do on their side when it comes to ensuring that their systems and data are protected.

Here, two healthcare provider CIOs and a deputy CISO offer their expert guidance for working with public clouds based on their experience with these increasingly helpful technological tools.

Medical devices must be managed from a security perspective, but also from an operational perspective. Using analytics to establish behavior baselines helps support risk assessments, find malfunctions and enhance staff productivity. From a cybersecurity perspective, I believe the healthcare industry is in a growing medical device crisis. The emerging trend of ransomware attacks on medical devices has created serious vulnerabilities in healthcare security.

Ransomware threats, and their implications for medical devices, center around the wide adoption of easily compromised operating systems on these devices, creating a growing vulnerability with potentially life-threatening ramifications. And what many people may not know is that ransomware attacks on medical devices have already occurred.

The social media platform Twitter allows users to post content up to a limit of 280 characters, the engagement with these posts can be measured by the number of impressions. With all this content available, hashtags (#) are used to group certain posts relating to a certain topic, a popular cardiology hashtag being #CardioTwitter.

In particular, the free open-access medical education (#FOAMed) hashtags have gained significant popularity. By using these hashtags, clinicians of all levels can get involved in discussions and advise from around the world on echocardiograms and angiograms etc. This has also impacted the younger generation of cardiologists as the fellows-in-training (FITs) have also been able to use SoMe to generate a hashtag, #FITSurvivalGuide, which provided access to basic clinical topics. For academic cardiologists, SoMe has also become more prominent in their field. It is now not uncommon for academics to demonstrate the impact of their work digitally.

The opportunity for SoMe to generate real-world connections has brought together different groups in the field from around the world. For example, the Women in Cardiology movement has gained a large following on both Twitter and Facebook. These SoMe platforms have allowed this group to discuss issues of importance affecting the female cardiologist population, including issues with the gender pay gap and work-life balance challenges. Connections have also been made for grassroots cardiology advocacy groups, for example, #GoRedForWomen and #SouthAsianCVD to name a few.

While voice has been touted as an emerging technology with the ability to lower the bar to entry, industry players are now starting to warn of privacy gaps. Amazon Alexa and Google Home devices are now becoming a frequent household item, used for everything from ordering a new wardrobe to helping with homework.

But when used in the medical industry, the technology needs to be administered differently than in the consumer world.

“When it comes to healthcare and voice design, we have several challenges we face every day,” Freddie Feldman, voice design director at Wolters Kluwer Health, said at The Voice of Healthcare Summit at Harvard Medical School last week. “HIPAA is a big topic on everyone’s mind nowadays, and it is one we take seriously. The first thing most people think about when they hear HIPAA is securing servers platforms, but there is more to it. We have to consider things like the unintended audience for a call.”

He said that due to the nature of voice, even leaks not expressly prohibited by HIPAA can be inappropriate. For example, if the voice technology is intended for home use and gives a message from the radiology department to the house, then it’s giving away too much information, he said.

Much of it comes down to appropriate use. For example, putting the speakers into a hospital room setting poses a different set of challenges.

China’s one-stop healthcare ecosystem platform Ping An Good Doctor, officially launched its Private Doctor service last week in China on August 13. On the same day of launch, the company also entered into partnership with 29 companies including China Mobile Internet, BAIC Group, China CITIC Bank, Wyeth Nutrition, China Everbright Bank, Minsheng Life, Pearl River Life and PKU Founder Life. The 29 enterprises operate in industries such as banking, insurance, automobile, communications, and maternity services with a total contractual amount of over RMB300 million.

Michigan Health Information Network Shared Services (MiHIN) continues to expand the services it offers statewide, including the creation of a sandbox environment to enable healthcare organizations to simulate and test interoperability scenarios and a recently announced partnership with Care Convene, a telehealth platform.

In a recent interview, Tim Pletcher, MiHIN’s executive director, described the organization’s approach as a “use case factory.” MiHIN has created a methodology to work on bringing new use cases such as admission, discharge and transfer (ADT) notifications into production and add to their portfolio of shared services. “We put the use cases through a pipeline, including working with the state government or commercial payers to align financial or policy incentives. We have had payers involved in every single use case we have,” he stressed.

Once a new use case is in place, MiHIN runs the report cards on how health systems are doing. Are they sending data and how clean is the data and how consistent? “We are like teachers who want everyone to get an A,” Pletcher said. “We send report cards home to Mom and Dad – the payers or the state government. They decide whether they are going to give everyone their allowance. We don’t measure HIE participation, because just being part of a club does not mean you are creating value. But at the use case level, it does. For instance, we have 330 of the long-term care facilities/SNFs sending ADTs in Michigan, which is quite novel, but it is because we were able to create incentives to motivate them to do that.”

To help organizations work through issues with data sharing, MiHIN has a new nonprofit subsidiary called the Interoperability Institute and it has set up a sandbox environment called “Interoperability Land,” described as a shared online environment hosted in the Amazon Web Services Cloud where organizations, developers, and technology providers can engage in simulated interoperability scenarios to develop, test or demonstrate new application capabilities. It uses completely realistic but synthetic patient data.

“We started with immunizations, so people could practice submitting to the state registry,” Pletcher explained. “Very quickly we moved to ADTs and CCDAs, because nobody had any data to start priming the pump and work out all the kinks.”

Share Facebook Twitter LinkedIn Email Print Federal healthcare policymakers are pushing to give patients easier access to their electronic health data via smartphone apps. The private sector also is playing a role in these efforts—Apple launched its Health Records feature in January 2018, and now more than 200 healthcare providers have joined the project.

Are patients actually using these apps to get their health records? At this early stage, uptake has been modest, but the numbers are growing, according to an assessment looking at 12 early-adopter health systems published in JAMA Network Open.

Julia Adler-Milstein, Ph.D., an associate professor of medicine at the University of California, San Francisco School of Medicine and Christopher Longhurst, M.D., chief information officer and associate chief medical officer at UC San Diego Health, evaluated the use of health record application programming interfaces with the aim of creating baseline national measures of patient uptake against which to track future progress.

The National Institutes of Health-led All of Us precision medicine health research database project has enrolled 230,000 participants as of July 2019, with an additional 40,000 people registering on the website, according to researchers involved with the project.

Of those participants, 175,000 have contributed personal information, biospecimens, physical measurements and shared electronic health record data, researchers from participating organizations, including the Vanderbilt University Medical Center’s Departments of Biomedical Informatics and Medicine, the National Center for Advancing Translational Sciences, and the National Institutes of Health wrote in a report published in the New England Journal of Medicine on Thursday.

When the NIH announced the All of Us initiative in 2015, it kicked off the largest health and medical research program on precision medicine with the goal of collecting health data on 1 million people. The program opened enrollment nationwide in May 2018 after an extensive period of beta testing.

Traditional clinical trials are equivalent of billions of dollars and years of hard work with no guarantee for the new drug to be approved by regulatory bodies, not to speak about the dangers of testing medication on animals and/or humans. What if we could take a radical turn? What if we conducted clinical trials on virtual bodies that could perfectly mimic human physiology? With the help of artificial intelligence, enhanced computer simulations, and advances in personalized medicine, in silico trials might be a reality in the coming years.

Like all hospitals, McLaren Port Huron in Michigan is constantly searching for ways to reduce our readmission rates. No small task, considering that one of every six discharged patients in the United States is readmitted in fewer than 30 days, and a third of those within only seven days of discharge, according to a March 2019 article from Forbes.

As McLaren’s clinical outcomes coordinator, I’ve done a lot of research over the years to discover the best way to do this. And everything I’ve read points to one thing – readmissions can be largely attributed to what happens after the patient leaves our care. Even with a team of the most dedicated physicians, nurses, and other clinicians, we can only do so much to address factors such as healthy eating, medication adherence and the availability of transportation to follow-up appointments after the patient is discharged. And it’s precisely these factors – all impacted by larger social determinants of health (SDOH) to one degree or another – that influence whether (and how soon) our inpatients become readmission statistics.

In fact, a report from the Yale Global Health Leadership Institute notes that actual medical care only makes up 20% of what determines a patient’s health; the rest is determined by genetics (20%) and the majority by social, environmental and behavioral factors (60%).

The Food and Drug Administration (FDA) Orange Book is now in its 39th edition. The information in the book stems from the requirement of the FDA to provide states information regarding pharmaceutical therapeutic equivalence. States were creating formularies and looking for options to keep costs down yet ensure equivalence. Over time the physical then online and now app version of the Orange Book called Orange Book Express was created.

Today the book contains information on new drug approvals, new patent applications/approvals/discontinuations, etc. The book is updated monthly. The newest version is available for both iOS and Android and has improved search security. Examples of useful information one can quickly access from the app based on the June update includes newly added patents for the inhaled insulin, afrezza, and patent discontinuation for the blockbuster erectile dysfunction drug from Lilly, Cialis. The app divides information into convenient sections such as “Newly Added Patents,” “Patent Delistings,” and web-based information. The app’s overall search function allows the user to search by active ingredient, applicant holder, application number, patent number, etc.

There is a big push both from the private market and federal policymakers to improve interoperability and open up access to health data through smartphone apps and other digital tools.

But on the front lines of healthcare, the way patient information is shared remains largely a manual process done through a combination of faxes, emails, phone calls and paper records, according to a recent study on transitions of care.

The chief medical officer of one hospital admitted that “the routine is patients leave with an envelope full of their chart, and we don’t have shared EHRs,” according to the report from PointClickCare, a cloud-based electronic health record (EHR) vendor.

Healthcare’s digital transformation is still in the early stages of maturity relative to other sectors, but CIOs do understand the imperative to drive digitalization, according to a new report from advisory firm Damo Consulting.

The report’s findings were revealed in focus group discussions with nearly 40 CIOs and senior health IT leaders who are members of the College of Health Information Management Executives (CHIME). When asked to define digital transformation in healthcare, 60 percent of respondents said it is about using digital technologies to reimagine business processes and customer experiences, while others stated that it means delivering healthcare when, where and how consumers want it; or using data, analytics and artificial intelligence (AI) to improve outcomes.

According to the researchers, today, health systems fall into four key models of digital adoption: reliance on electronic health record (EHR) systems to drive digital engagement (Model 1); digital strategy singularly focused on virtualization of care (Model 2); stand-alone digital initiatives driven by internal demand (Model 3); and strategic investments in long-term digital health platforms (Model 4).

Most health systems, especially smaller and mid-tier ones, operate in Models 1 and 2 and only the nation’s largest health systems are operating in Model 4. The majority of CIOs in the focus group, however, acknowledge that all enterprises need to shift to Model 4, the findings revealed.

“In my discussions with health system CIOs, what emerged is that not only are most health systems in the early stages of adoption, but there is no clear consensus on what digital transformation looks like or how to achieve it,” said Paddy Padmanabhan, CEO, Damo Consulting. “Most health systems consider their EHR system as their digital strategy or are developing standalone solutions on an as-needed basis, without a long-term digital strategy in mind.”

Healthcare enterprises that use Amazon cloud services may be at risk of data breaches if they don’t select the right configuration settings for Elastic Block Storage snapshots, warns Ben Morris, a senior security analyst at Bishop Fox. Morris’ research found that big firms, including technology companies and health care providers, have inadvertently left data publicly vulnerable, and Morris estimates that the number of exposures could be as high as 1,250.

More than 24 health care organizations joined AHIMA in support of a proposal to require the use of US Postal Service standards for addresses in EHRs, and some also suggested using additional data captured in EHRs, such as email addresses and phone numbers, to improve patient matching. A recent study found that adopting the USPS standard could reduce the number of unlinked records by 20%, and standardizing surname as well could cut the number of unmatched records in half.

Two healthcare vendors, Medico and Amarin Pharma, recently confirmed two separate security incidents around misconfigured databases, potentially breached the sensitive data of thousands of patients.

We strongly believe that only digital health can bring healthcare into the 21st century and make patients the point-of-care.

1. A patient stops by a busy urgent care center for concerning flu-like symptoms. Rather than waiting a couple hours just to start being seen by the nurse, the patient sits at a kiosk and interacts with an artificial intelligence (AI) assistant that asks the patient some questions tailored to the signs and symptoms. The patient can even follow easy instructions to take her own temperature, capture pictures of her ear drums using a digital otoscope and record her heart and lung sounds. The AI system then records this information, infers a probable diagnosis of influenza and sends the information to the clinician’s electronic medical records (EMR) with the Subjective Objective Assessment Plan (SOAP) note mostly filled out. Now, when the patient sees the clinician, most of the work is done and the time can be spent between the patient and clinician discussing the diagnosis and treatment plan.

2. Another busy patient is on a ranch and has developed a rash. It’s an hour drive to the nearest doctor or urgent care. So instead, the patient uses his phone and sets up a telehealth visit with a doctor right then. The doctor can review the patient’s previous history obtained from the medical record, look at an uploaded picture of the rash sent by the patient and converse with the patient over video. The document note would then be sent back to the EMR along with the rest of the patient’s record. The patient’s regular primary care provider can now access this encounter for follow up.

3. A busy doctor is seeing 30 patients a day in the clinic. Documentation and order entry is time consuming, but this doctor uses her phone and a special app to record the patient/physician encounter and use natural language processing and machine learning to turn this recording into a SOAP note. In addition, orders for labs and x-rays are captured during the encounter and sent to the EMR along with the SOAP note.

These scenarios are not science fiction. They represent new modalities of capturing patient information outside of the typical workflow—which I will call external apps for now. These modalities are working to be interoperable with the rest of the patient’s health information, which is typically stored in the medical record and claims databases. As their prevalence grows within the health IT ecosystem, it is important to understand how standards are being leveraged to integrate these applications.

Cerner, in collaboration with Duke Clinical Research Institute, will launch the Cerner Learning Health Network, which aims to automate data collection from multiple sources, including electronic health records.

WHY IT MATTERS Cerner and Duke say the initiative will enable clinicians to more easily and efficiently gain health insights and guide care. In addition, it aims to give medical researchers faster and easier access to data that can help them innovate new approaches to health.

The pilot of Cerner Learning Health Networks seeks to improve clinical research registries. DCRI’s Learning Registry will make use of Cerner technology to explore and assess proven therapies for chronic cardiovascular disease.

It will analyze de-identified patient data from the University of Missouri Health Care and Ascension Seton, in partnership with Dell Medical School at The University of Texas at Austin, with the goal of finding the most effective treatment options, officials say.

The hope is for Cerner Learning Health Network to have significant applications in life sciences, pharmaceuticals and healthcare at large, automating and streamlining health data for clinical research.

Cerner says its clients will be able to use its HealtheDataLab – which builds upon its HealtheIntent population health technology – with the network to aggregate de-identified patient data from both Cerner and non-Cerner EHRs.

Dr. Michael Sanders, CMIO at Flagler Hospital in St. Augustine, Florida, says clinicians are using unsupervised learning algorithms to reduce costs and prevent medical errors.

When it comes to the future of blood pressure monitoring, there may be a new alternative to the traditional cuff: a video selfie.

New research published in Circulation: Cardiovascular Imaging found that a smartphone-based blood pressure measurement that employs transdermal optical imaging technology was able to predict systolic and diastolic blood pressure with high accuracy.

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Researchers discovered that the models were able to predict systolic blood pressure with an accuracy of 94.81%, and diastolic blood pressure with an accuracy of 95.7%.

The study demonstrated that the technology is able to predict the blood pressure within the “clinically accepted accuracy threshold of 5 ± 8 mm Hg when tested on a full range of blood pressures,” the researchers wrote in the reads.