Pondering the squandering redux: $28 billion gone out the HITECH window

In 2009, the US Congress enacted the HITECH Act, as part of a much broader recovery measure (ARRA or ‘the stimulus’), authorizing the Department of Health and Human Services (HHS) to spend up to $35 billion to expand health IT and create a network of interoperable EHRs. Key to this goal of interoperability and seamless sharing of patient information among healthcare providers was achieving stages of ‘meaningful use’ (MU) with these EHRs in practice, to achieve the oft-cited ‘Triple Aim‘ of improved population health, better individual care, delivered at lower per capita cost. Financial incentives through Medicaid and Medicare EHR programs were delivered through multiple stages of MU benchmarks for hospitals and practices in implementing EHRs, information exchange, e-prescribing, converting patient records, security, patient communication and access (PHRs).

Five years on, $28 billion of that $35 billion has been spent–and real progress towards interoperability remains off in the distance. This Editor has previously noted the boomlet in workarounds for patient records like Syapse and OpenNotes. Yet even the progress made with state data exchanges (e.g. New York’s SHIN-NY) has come at a high cost–an estimated $500 million, yet only 25 percent are financially stable, according to a RAND December 2014 study. (more…)

EHRs can’t exchange patient records? $$ in workarounds.

Some of the Excedrin/Panadol Headaches (#11, #14, #23 and #54) in healthcare are around the very ‘miracle technology’ that was supposed to make it all seamless, non-duplicative, time/cost-effective and coast-to-coast–EHRs. The exchange of patient records between hospitals, within health systems between sites and with medical practices plus vice versa–works haltingly if at all. It works best within well-established, highly integrated delivery systems –the VA, DOD, Mayo Clinic, Kaiser, Geisinger, Intermountain Healthcare. But once you’re away from it–good luck. Where are the problems? The closed standards of the major hospital EHRs–Epic, Cerner, Allscripts, McKesson and brethren; the extreme customization most health systems demand (nay, a major Epic selling point!); structured versus unstructured data and how handled; a lack of a secure interoperability standard are but a few. Where is the gold? Getting patient health records exchanged, accessible and transportable, among systems that were essentially designed not to speak with each other. (more…)

Epic Systems getting into the app store business (US)

Epic Systems, the #1 company in the hospital and large practice EHR business, is launching its own app store, reportedly within a few weeks. This opens up interesting possibilities not only for mHealth app developers–who need application standards and guidelines soon–but also for Epic’s reputation as a closed system that shies away from interoperability with other EHRs like Cerner, Meditech and McKesson–a serious wrinkle with their Department of Defense EHR joint bid with IBM to replace AHLTA. The HIT Consultant article quotes a leading Epic customer consultant on that the first apps will be clinical, then crossing over into consumer; the latter seems an obvious move with PHRs (personal health records) as part of Meaningful Use requirements.

EHRs *do* take more time! (JAMA)

If your doctor or nurse is frustrated by their EHR, it’s not because they are a technophobe or klutzy on the keyboard. According to a research letter published in JAMA Internal Medicine (8 Sept), internal medicine physicians reported a loss of time of 48 minutes daily due to EHR use. 411 internal medicine attending physicians and trainees who worked in an ambulatory practice and used an EHR system responded to a 19-question survey in December 2012 by the American College of Physicians. The trainees reported a lower time loss–18 minutes. No conclusion is reached for this difference. Other findings indicated what took more time: (more…)

Electronic Alerts in EHRs Reduce Urinary Tract Infections (Study – US)

According to the World Health Organisation, urinary tract infections (UTIs) win top prize for most frequent health care-associated infection in high-income countries. And the cause?…A massive 75% of all of hospital acquired UTIs result from having a urinary catheter fitted (i.e. a tube inserted into the bladder through the urethra to drain urine). And it’s far from unusual to have this procedure done, for between 15 to 25 percent of hospitalized patients have one fitted during their hospital stay (Source CDC). Having a urinary tract infection can be nasty enough but if left untreated serious consequences can result including permanent kidney damage.

The most effective way to reduce the incidence of UTIs (apart from not having a catheter fitted in the first place) is by removing the catheter as soon as it is no longer needed. Unfortunately, all too often this does not happen. That’s why the findings from this new study from the University of Pennsylvania are significant. Results showed that automated alerts in Electronic Health Records (EHRs) reduced urinary tract infections in hospital patients with urinary catheters.

The EHR alert system worked by prompting physicians to specify the reason for inserting the patient’s catheter. On the basis of the reason selected, the system then helped them decide (a) whether urinary catheters were needed in the first place and (b) alerted them to reassess the need for catheters that had not been removed within a recommended time period. And it was no small-fry study. (more…)

Apple Health, minus the ‘book’, announced

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.

Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”

Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)

In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.

The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?

Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday?  Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?

Hat tip to Editor Toni Bunting

More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and MoreApple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.

Welsh Government to develop new eHealth and Care Strategy

The Government of Wales has announced that it is to develop a new eHealth and care strategy in [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Welsh-Goverment.jpg” thumb_width=”150″ /]conjunction with health boards, NHS trusts and local authorities in Wales. The strategy will focus on using technology such as video conferencing, remote monitoring and better use of health records.

In a written statement issued last week while the Welsh Assembly is on its break, the minister for health and social services states that consultation will take place with health and social care professionals and users and the strategy will be in place by the end of the year.

“This will help us achieve our aim of ensuring there are more services, care and support available for patients in their homes or in their local communities” says the statement from Mark Drakeford.

“Technology has a key role to play. This could include the use of video conferencing to allow patients and health professionals to talk to each other; to aid diagnosis and decision making and remote monitoring for people with particular health conditions. Technology can also help improve access to services by bringing them closer to people’s homes, for example by providing mobile services in rural areas.

“With an increasing ageing population it is essential we enable people to live independently for as long as possible. Without this, the health and well-being of individuals will be adversely affected.

“We will expect our information to be accessible to professionals where and when it is needed whether in health or in social care. We already have the Individual Health Record, with appropriate security and governance in place. Any potential wider access to people’s data would only be with their consent.”

The full statement is available on the Welsh Government website here.

Box.com’s odd swerve into healthcare cloud storage and PHRs

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /] Both The Gimlet Eye (filing from a remote island) and Editor Donna have been pleased users of the Box.com file storage site for storing all sorts of files in the ‘cloud’ (a/k/a Somewhere Out There On A Whole Bunch Of Internet Servers), sharing and collaboration. It’s simple to use, it works and, for our needs, actually free. However founders Aaron Levie and Dylan Smith, who look barely old enough to shave (but smartly have A Touch of Grey in their management team), have their eyes set on far bigger prizes than our mediocre needs. Now they have added ‘special advisers’ Aneesh Chopra, first US CTO, and Glen Tullman, former CEO of Allscripts. Mr. Tullman certainly does add major luster (and connections) and Mr. Chopra, despite the Eye’s consideration of him as hyperbolic and politically, not technically, qualified for his previous positions in the Government and the state of Virginia, adds the inevitable political ones. Having them on the roster also adds heft to their imminently rumored IPO (TechCrunch; update, filed 24 March) and ultimately acing out other file sharers Dropbox in the enterprise area. Expectations are high; Box has $414 million in funding from a roster of investors (including Telefónica and Australia’s Telstra) through a Series F (CrunchBase) with a valuation of $2 billion (TechCrunch) and undoubtedly they’d like some of it back. Soon. (The completely overheated Castlight Health IPO only whets the appetite.)

Healthcare one key to a rich IPO. Box’s healthcare moves point in the enterprise direction. (more…)

Reflections on the NHS Innovation Expo (UK)

Editor Charles visited the Expo in Manchester on Tuesday 4th March – here are his personal reflections.

I decided to devote the one day I had to visit the NHS Innovation Expo to visiting stands to try to spread the word about DHACA that was launched last week.

The first thing I noticed about the event was that it seemed less crowded than previous ones. When passing them, I never saw the main auditoria full either, very much in contrast to earlier Expos.

The other principal observation was that (more…)

Mobile in healthcare: HIMSS Analytics infographic

You can read the full 3rd Annual HIMSS Analytics Mobile Survey of 170 health IT and clinical staff or treat yourself to the highlights in this infographic. It summarizes key findings such as 59 percent have a mobile technology plan and 29 percent are developing a mobile technology plan; 62 percent indicated that they offer patients access to at least one of the mobile tools identified in the research, including patient portals, telehealth services and remote monitoring devices; only 22 percent indicated that three-quarters of the data captured by mobile devices was integrated into the organization’s EMR. Developed by HIT Consultant.

VA, DoD aren’t collaborating on EHR: GAO

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

AliveCor links with Practice Fusion

Breathlessly noted in today’s mHealth blogosphere is AliveCor’s partnership announcement with EHR giant Practice Fusion to integrate their patient-generated ECG information. According to the release, the 100,000 physician base of Practice Fusion will have the option to import AliveCor ECG data into patient records. This is a major breakthrough for AliveCor, which just gained FDA over-the-counter clearance for its snap-on case [TTA 11 Feb]. The AliveECG app also enables physicians to obtain an expert review of the ECG data, annotate and electronically transfer this data into the EHR within seconds. Is this the confirmation that AliveCor is the ‘product of the year’ as the Forbes article puts it? Or just an indicator where mHealth with clinical quality could be going?  (Let’s see if other EHRs like Athenahealth join the trend.) Release

An essential link to mHealth devices and apps?

Guest columnist Lois Drapin thinks so. She shares her insights on Validic, an emerging company in data integration for payers, providers, preventive wellness companies and pharma;how it evolved from its original concept in consumer health engagement, along with a few pointers its founders have for fellow entrepreneurs.

One of the keystone aspects of “ecosystems” is interoperability and this also applies to the data pipeline that flows from health apps and devices to the appropriate segment of the healthcare delivery system, and eventually, to the users—patients, consumers and/or medical professionals such as physicians and nurses or other clinicians. By now, we all know that the capture and analytics for both “big” and “small” health data are business imperatives for healthcare in the US. With data of this nature, we can embrace our understanding of behavioral change at the individual and population levels. The anticipated outcomes of behavioral change may power operational and cost efficiencies in the healthcare industry.

But data will no longer come from just inside the healthcare delivery system. In addition to the changing technology enablement within the health system, as we all know, data will flow from many things—in fact, The Internet of Things (IoT). This means that data that relates to our lifestyle, wellness and health will pour from the many types of wearable devices not now connected to the heath delivery system. In addition to our computers, tablets, phablets and smartphones, are the many sensors paired with tech innovations such as the wearables— from wristbands, smartwatches, clothing (from shoes to headbands), glasses, contacts, and pendants — to things such as refrigerators, clocks, mattresses, scales, coffee pots, cars, and even, toilets…all of which are predicted to become an important market in the coming years.

Validic, based in Durham, NC, has put itself smack in the middle of that market (more…)

US, UK agreement on HIT

Edited from the HHS releaseUS Health & Human Services (HHS) Secretary Kathleen Sebelius and UK Secretary of State for Health Jeremy Hunt on Thursday 23 January signed a bi-lateral agreement for the use and sharing of health IT information and tools. The agreement strengthens efforts to cultivate and increase the use of health IT tools and information designed to help improve the quality and efficiency of the delivery of health care in both countries.  The two Secretaries signed the agreement at the Annual Meeting of the HHS Office of the National Coordinator (ONC) for Health Information Technology. It concentrates on four key areas identified at the joint June 2013 summit:

  • Sharing Quality Indicators
  • Liberating Data and Putting It to Work
  • Adopting Digital Health Record Systems
  • Priming the Health IT Market

Collaboration efforts will be showcased at the Health Innovation Expo conference at Manchester Central 3-4 March (two weeks before HC2014) and the Health Datapalooza on 1-3 June in Washington, DC. A possible good sign for telehealth as there’s a great deal of mention of ‘preventive interventions’, ‘accessing and sharing data’ and the ‘health IT marketplace’.

Full memorandum of understanding text here. Also iHealthBeat.

EHR interoperability redux for VA, Department of Defense (US)

Back in late February, the US Department of Defense and Veterans Affairs announced that they would not achieve their goal of a single EHR by 2017, and would stick with their creaky AHLTA and VistA systems for the foreseeable future [TTA 3 April]–along with the general lack of interoperability–eyes rolled at the $1 billion down the drain, but seemingly not much else budged. (And this does not include the $4 billion spent on failed updates and fixes in both systems–TTA’s ‘Pondering the Squandering’, 27 July) To this Editor’s utter shock, the 2014 National Defense Authorization Act (NDAA), agreed to by the House and Senate this week, mandates a plan for either interoperability or a single system by 31 January–about 6 weeks from now–and to adopt it by 2016. Moreover, both systems must be interoperable with private providers based on national standards by 1 October 2014. A close reading of the NextGov article indicates that the bill adds levels of complexity and perhaps unworkability. Getthereitis, anyone?–or does this sound like Healthcare.gov, redux? FierceMobileHealthcare

And it takes a grad student to find a major info security flaw in VistA.  (more…)