Personal health ‘big data’ exchange is all good, right? Perhaps wrong.

Many of our recent stories have touched on ‘big (health) data’ as Achieving the Holy Grail–how it can be shared, how it can work with the Internet of Things and how poorly implemented personal health record (PHI) databases can derail national health systems (and careers) [TTA 22 Sep]. They are, after all, 1) extremely difficult to design to preserve privacy and 2) must satisfy patients’ requirements for easy use as well as privacy including opting out. But when despite all good intentions, data goes awry, the consequences can be severe.

  • A daughter applies for health insurance from Aetna, and her mother’s medications, about which she had no knowledge, are attributed to her. How? Data mining off Milliman’s IntelliScript data service which mixed up the records.
  • EHR exchange can spread errors such as a dropped critical health or medication record. One led to the death of an 84 year old woman. VA also had a problem with its EHR (not cited but likely VistA) slotting medication histories into the wrong patients’ files. An Australian hospital mixed up discharge files in electronically sending them to doctors. The more records are exchanged, the more possibility there is for propagation of errors.
  • More information is shared with third-party suppliers; survey companies are increasingly tapping into these databases to send annoying, potentially privacy-invading treatment questionnaires to individuals.

Bloomberg Business’ conclusion is that this could be a problem, but much beyond the tut-tutting doesn’t get into solutions. The Pitfalls of Health-Care Companies’ Addiction to Big Data

Is ‘pure’ robotic telesurgery nearing reality?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/09/Nicholson-Center-FL.jpg” thumb_width=”150″ /]Moving beyond robot-assisted surgery (e.g. the well-accepted use of the daVinci system with prostate surgery), controlled by a surgeon present in the operating room, is telesurgery, where a remote surgeon uses a robot to fully perform surgery at a distant location. The Nicholson Center at Florida Hospital in Celebration, Florida, which specializes in training surgeons and technicians in leading (bleeding?-Ed.) edge techniques, is studying how internet latency (lag time to the non-techie) affects surgical effectiveness. Latency is defined in this case as “the amount of delay a surgeon can experience between the moment they perform an action to the moment video of the action being carried out at the surgery site reaches their eyes.” Their testing so far is that internet latency for surgery between hospitals has a threshold of 200-500 milliseconds before dexterity drops off dramatically (not desirable)–and that given the current state of the internet, it is achievable even at a mid-range distance tested (Florida to Texas). Making this a reality is highly desirable to military services worldwide, where expertise may be in, for example, Germany, and the casualty is in Afghanistan. It would also be a boon for organizations such as the Veterans Health Administration (VA) where resources are stretched thin, rural health and for relief agencies’ disaster recovery. ZDNet

Defense, VA EHR interoperability off the tracks again: GAO

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”175″ /] According to the US Congress’ Government Accountability Office (GAO), the birddog of All Things Budget, the Department of Defense (DOD) and Veterans Affairs (VA) missed the 1 Oct 2014 deadline established in the Fiscal Year 2014 National Defense Authorization Act (NDAA) to certify that all health data in their systems met national standards and were interoperable. Modernization of software–a new Cerner EHR for DOD, modernization of VistA– is also behind the curve with a due date now beyond the 31 Dec 2016 deadline until after 2018. Finally the DOD-VA Interagency Program Office (IPO), which shares health data between the departments, has not yet produced or created a time frame nor “specified outcome-oriented metrics and established related goals that are important to gauging the impact that interoperability capabilities have on improving health care services for shared patients.” iHealthBeat, GAO report

The NHS fail at encouraging digital health startups

While Minister of Life Sciences George Freeman MP speaks very highly of the need for innovation and digital health in an NHS integrated health system, the reality is less encouraging for UK startups and their growth. The story of Big Health’s Sleepio and its move from the UK, told by Bloomberg, illustrates the difficulty that new companies and technologies have in fitting into a national framework, then selling into the 209 NHS regions plus related healthcare spenders. The long cycle and the narrowness of the frameworks are disincentives for many digital health technologies and their funders. Even if you win clients as part of being on the framework, when it expires after a few years, the business can be lost.

It’s hard to crack the code, and small companies are dependent on partners. A personal anecdote from this Editor’s time at Living Independently: the company achieved getting on a national framework with the QuietCare telecare product (2007) through partnerships with several larger telecare providers. We relied on them to offer QuietCare to the regions and councils. This had limited success and the US business far outstripped that in the UK.

Ten years ago, the situation was reversed. NHS, Government and council funding helped the earliest development and acceptance of telehealth and telecare, much as the Veterans Health Administration (VA) did with home telehealth and telemedicine in the US.  Other European markets and Canada have established private spending in this area, but these smaller markets–and funders– don’t have the potential that is possible in the US private market, even without reimbursement. The trend is reflected in investment: $4 bn in the US, less than €100 million in Europe. US developers now have a bonus in the potential of Asia, with China having the greatest interest and now funding. [TTA 23 July].  How the NHS Is Locking Out Britain’s Digital-Health Startups

Cerner win at Defense a crossroads for interoperability (US)

Modern Healthcare’s analysis of the Cerner/Leidos/Accenture win of the Department of Defense (DoD) EHR contract focuses on its effect on interoperability. In their view, it’s positive in three points for active military, retirees and their dependents.

* EHR interoperability with the civilian sector is needed because 60-70 percent of the 9.6 million Military Health System beneficiaries—active duty military personnel, retirees and their families—is delivered by providers in the US private sector through Tricare, the military health insurance program.

* A major criticism by Congress and veterans’ groups of both DoD and VA is the lack of interoperability between these systems as well as civilian. Many military members change their status several times during service, and can cycle within a few years as active, Reserve, National Guard and inactive reserve. Records famously get lost, sometimes disastrously.

* It’s a boost to state health information exchanges (HIE) in states with large military bases and also for the CommonWell Health Alliance, an industry group which is establishing EHR interoperability standards.

Less optimistic are some industry observers who see the DoD contract as sidelining resources demanded by Cerner’s civilian hospital clients, and whether realistically they can develop a system to exchange data with every EHR, including dental, and e-prescribing system in the US (and probably foreign as well). Modern Healthcare

US Department of Defense picks Cerner/Leidos/Accenture for $4.3 bn EHR

Breaking News Updated  The winner of the massive, potentially ten year contract for the Defense Healthcare Management System Modernization program is defense computer contractor Leidos, which brought in Cerner and Accenture Federal Systems.The DOD announcement mentions only lead contractor Leidos, interestingly under the US Navy Space and Naval Warfare Systems Command, San Diego, California. The announcement was released just after 5pm EDT today.

This combination beat the Epic/IBM and the Allscripts/Computer Sciences/HP bids. According to the DOD announcement, “This contract has a two-year initial ordering period, with two 3-year option periods, and a potential two-year award term, which, if awarded, would bring the total ordering period to 10 years. Work will be performed at locations throughout the United States and overseas. If all options are exercised, work is expected to be completed by September 2025. Fiscal 2015 Defense Health Program Research, Development, Test and Evaluation funds in the amount of $35,000,000 will be obligated at the time of award.” Modern Healthcare attended the embargoed press conference this morning and adds in its article that only one-third is fixed cost, with the remainder as ‘cost plus’, which could conceivably run the contract to the $4.33 bn ceiling over the 10 years. The system will be used in 55 military hospitals and 600 clinics, with an initial operational test as early as 2016 (Washington Post) and full rollout by 2023.  Interoperability with private EHR systems was a key requirement (Healthcare IT News).Over the 18 year life cycle, the contract value could be up to $9 bn, according to the WaPo.

The race to replace DOD’s AHLTA accelerated with the final failure to launch a plan to create a joint DOD-VA EHR in March 2013 [TTA 27 July 13], though hopes revived in Congress occasionally during the past two years [TTA 31 Mar].

It is also widely interpreted as a blow to Epic, which has been defensive of late about its willingness to play in the HIT Interoperability sandbox with other EHRs; certainly it cannot make Big Blue, which would undoubtedly have found some way to sell Watson into this, happy.

POLITICO’s Morning eHealth had many tart observations today, mostly pertaining to the belief of some observers that Cerner will be strapped in meeting this Federal commitment and would find it increasingly difficult to innovate in the private sector.

Example–From Micky Tripathi, CEO of the Massachusetts eHealth Collaborative: “My biggest worry isn’t that Cerner won’t deliver, it’s that DOD will suck the lifeblood out of the company by running its management ragged with endless overhead and dulling the innovative edge of its development teams. There is a tremendous amount of innovation going on in health IT right now. We need a well-performing Cerner in the private sector to keep pushing the innovation frontier. It’s not a coincidence that defense contractors don’t compete well in the private sector, and companies who do both shield their commercial business from their defense business to protect the former from the latter.”

Unnerving mergers (US-UK); DoD’s EHR picked; EHRs & AMA

Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.

Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.

Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later.  Leidos/Cerner announced as winners close of business Wednesday 29 July. 

In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management 

Possible early detection test for chronic traumatic encephalopathy (CTE)

A research study published today in the Proceedings of the National Academy of Sciences (US) presents the results of screening 14 retired professional American football players with suspected CTE. Using a tau-sensitive brain imaging agent, [F-18]FDDNP, the California and Illinois-based researchers were able to detect the abnormal accumulation of tau and other proteins, in the distinct CTE pattern, in the brains of living subjects who had received, during their playing careers, multiple concussions and head trauma. Of the 14, one had been diagnosed with dementia, 12 with mild cognitive impairment and one with no symptoms. Previous studies, such as Robert Stern, MD‘s pathfinding research at Boston University and for the NFL (see below), have been primarily post-mortem on brains donated for research, although Dr Stern’s last presentation at NYC MedTech and Inga Koerte, MD of the Ludwig-Maximilians-Universität München (LMU) have also used brain scan information on live subjects in their studies.

Where this differs is that the imaging agent injected binds to the tau  (more…)

Another go at a joint DOD-VA EHR? (US)

As this Editor was Pondering the Squandering last week of $28 billion HITECH Act funds meant to achieve EHR interoperability but falling well short, we recalled another Big EHR Squander: the integration of the Department of Defense’s (DOD) AHLTA with the Veteran Affairs’ VistA, an iEHR effort which collapsed in February 2013 at a mere $1 billion, in addition to dysfunctional or failed upgrades in both systems at just under $4 billion [TTA 27 July 13]. For civilians, this may not sound like much for concern, but for active duty, Reserve and National Guard service members transitioning from active to civilian status (and back as they are activated), often with complicated medical histories, it means a great deal.

At least one Congressman who also happens to be a physician, Representative Phil Roe, MD (R-TN) wants to try, try again. According to Politico’s Morning eHealth of last Wednesday, his bill will offer “a $50 million prize to the creator of an integrated military-veteran medical records system.” plus another $25 million over five years to operate it. DOD is moving forward with an $11 billion bid for a new EHR, but Rep. Roe’s staff issued a statement that differs with the DOD’s–that the new EHR still has no provision for secure and relatively seamless interoperability with the VA system to streamline the transfer of claims. We wish the best to Rep. Roe, and hope he can overcome Congressional inertia and two huge bureaucracies amidst doubts on the DOD’s EHR award process. FierceEMR on Roe bill, award process and adoption concerns by GAO and others. Also Anne Zieger in Healthcare Dive, iHealthBeat.

Veterans Affairs boosts telehealth, HIT in proposed 2016/2017 budgets

The US Department of Veterans Affairs (VA), in its proposed 2016 budget released earlier this week, is increasing support for telehealth/mHealth along with programs that use these services–rural health and mental health. Telehealth’s VA budget from FY 2014 increased from $986 million to just below $1.1 billion in the current year. In FY 2016 (beginning 1 Oct), the VA is allocating $1.22 billion of a $56 billion budget, and in 2017 advance appropriations, $1.37 billion–a year-to-year increase of 11 percent and 12 percent respectively .

VA has the largest telehealth program in the US, divided into three main functional areas: (more…)

VA calls IBM Watson for decision making, PTSD assistance (US)

The US Department of Veterans Affairs (VA) Veterans Health Administration (VHA) area is working with IBM Watson to develop and pilot a Clinical Reasoning System to assist and accelerate decision making by primary care physicians. The $6.8 million, two-year project will concentrate on acquiring and analyzing the data generated by hundreds of thousands of VHA documents, medical records, EMRs and research papers. The second focus of the VA-Watson relationship will also include mental health–supporting veterans with PTSD who constitute 12-20 percent of US veterans from Vietnam to present. The pilot phase, interestingly, will use simulated, not real, patients.

(more…)

12 percent of US veterans now using VA telehealth services

The US Department of Veterans Affairs (VA) has some good news (for a change)–that during the just-closed Federal FY 2014, 690,000 veterans, or 12 percent, used telehealth services. This was a 13.3 percent increase over FY 2013 (608,900). While this report is preliminary (beware!), we see a slowing of growth in the number of veterans accessing telehealth and a concentration–not dispersal–of telehealth services in rural areas (+ 10 points). This chart compares the numbers:

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/VA-2014-vs-2013.jpg” thumb_width=”350″ /]

Chart: EIC Donna. Please note that percentage of telehealth users add up to over 100 percent due to usage (one patient could access two or three forms of telehealth. FY14 telehealth user breakout is estimate based on FY13 percentage, to be eventually compared to official figures.)

Telehealth as defined by VA: (more…)

The King’s Fund videos, presentations online

The King’s Fund has posted video highlights from last month’s International Digital Health and Care Congress. Talks include those from futurist Ray Hammond, Kathleen Hammond (US Department of Veterans Affairs), Dr Ali Parsa (Babylon), Paul Rice (NHS England) and Sian Jones (NHS Bristol). Click on the tabs at top for presentation decks and posters. TTA was a media partner of the Congress. Hat tip to Mike Clark via Twitter (@clarkmike).

Brain neuroprosthetics, stimulation for TBI, PTSD

A signature injury of the Iraq and Afghanistan wars has been traumatic brain injury (TBI), as well as an outcome of all wars–post-traumatic stress disorder (PTSD). Over 270,000 veterans since 2000 have been diagnosed with TBI–along with 1.7 million civilians per year. The US Department of Defense (DOD) has been funding research in several areas to help veterans–and eventually civilians–with these traumas.

  • DARPA’s RAM: Restoring Active Memory program is seeking to compensate for brain injury by developing a neuroprosthetic to aid memory function. (more…)

VA reduced bed days by 59%, hospital admissions by 35% in 2013

Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.

  • The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
  • 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
  • Cost savings are estimated at just under $2,000 per year per patient
  • Over 41,000 patients were enabled to live independently in their homes using telehealth
  • VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
  • The program is expanding at a rate of 22 percent per year

VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)

A snapshot of telehealth and telemedicine in rural America

Telehealth and telemedicine (virtual consults) are moving forward in large and largely rural Nebraska and neighboring Iowa. The Nebraska Medical Center not only has an executive director for telehealth (not buried in an HIT department) but also no less than 13 initiatives in process from stroke to cancer care. Video networks connect rural hospitals with medical centers. The VA’s leadership in this geographic area has been crucial, with over 550 patients in home telehealth in Nebraska – Western Iowa and additional telemedicine programs for psychiatry, wound care, nutritional counseling and infectious diseases. Videoconferencing equipment in hospitals and public health centers, installed in a mid-2000s program, is being repurposed for video consults. Interestingly, its use in this region is not new. For 10 years, a University of Nebraska Medical Center (UNMC) psychiatry associate professor has been having routine video psychiatric consults with elderly nursing home patients. Telemedicine’s first use in Nebraska was also psychiatric–55 years ago–by a University of Nebraska Medical Center dean using undoubtedly black-and-white two-way video. Doctor’s home visit is back — kind of — as telehealth flourishes nationwide (?–Ed.), Omaha World-Herald