November 26, 2013 1:00 PM
Posted by: adelvecchio
, Interoperability and health information exchange
Today’s health information exchanges are slowed by a lack of system interoperability, but that could be resolved if more vendors would develop integration solutions and adopt standardized pricing for their products, health information exchanges said in the eHealth Initiative’s 2013 Health Data Exchange Survey.
Of the 199 data exchange initiatives that were surveyed, 68 responded that they have had to connect with more than 10 different systems. Interoperability with other health IT systems has been problematic for 142 of the exchange initiatives.
“It’s relatively simple for providers within a hospital using a single EHR to share information about their patients. The real challenge and expense is getting dozens of different systems to talk to each other,” said Jennifer Covich Bordenick, CEO of the eHealth Initiative, in a release.
Nearly all (151) of the initiatives have had to build multiple interfaces to communicate with different systems. The cost and complexity of engineering an interface were commonly cited in the survey as obstructions to interoperability. Those difficulties could be eased if vendors heed the exchange initiatives’ call for integration solutions.
The technological aspects of health information exchange often overshadow the goal of sharing patient data. Two of Michigan’s largest HIEs, Michigan Health Connect and Great Lakes Health Information Exchange recently reached a deal to securely share patient information. The agreement enables data sharing among 96 of the state’s approximately 117 hospitals.
Farzad Mostashari, M.D., former national coordinator for health IT, continued to push for greater interoperability and HIE progress while he was on his way out of office. Mostashari aimed to clarify ONC’s plans for information exchange after HHS received more than 200 responses to a request for information about HIE. Representatives from the Centers for Medicare and Medicaid Services seconded Mostashari’s message about accelerating HIE adoption, saying they are working on tying HIE use to reimbursement.
November 19, 2013 1:30 PM
Posted by: adelvecchio
, EHR security
, open source
, Vista EHR
A term project by a Georgia Tech graduate student lead to the discovery of a security vulnerability in the U.S. Department of Veterans Affairs (VA) EHR system. As a result, the VA collaborated with the open source EHR community to improve the security of their vulnerable Veterans Health Information Systems and Technology Architecture (Vista) EHR system. To do so, the VA teamed with Open Source Electronic Health Record Agent (OSEHRA) to create a patch for users.
The goal of the student, John Mackey, was to show the vulnerability of large critical infrastructures. He chose to experiment with Vista because of its increasing use in private facilities, as well as VA hospitals. The flaw Mackey discovered was that certain formatting could allow the sender to perform a number of remote commands without authentication, according to OSEHRA.
“A single interested individual found a vulnerability that impacted the entire community. Every VistA user can use the resulting patch to improve security for their patients,” said Seong Ki Mun, CEO of OSEHRA, in a release announcing the collaboration.
The deployment of open source EHRs has gained traction in other corners of the healthcare field. A study conducted by the National Opinion Research Center at the University of Chicago showed that five out of six participating sites “found a number of advantages in the use of their open source EHR system.” Three of the sites used a version of Vista. The sites that were satisfied with their open source EHR system believed so because it supported patient care and streamlined workflows within their facility.
Intermountain Healthcare has pledged $25 million to an open source telemedicine software project; the results of which will ultimately be turned over to the U.S. healthcare system and telemedicine vendors. Their goal in establishing this project is to increase access to better care for patients and to educate clinicians on how and when to use telemedicine technology.
November 14, 2013 11:17 AM
Posted by: DonFluckinger
, cancer registry
, clinical trials
, healthcare informatics
, patient engagement
The White House Office of Science and Technology Policy announced a group of big data research and development projects, many focusing on healthcare. It not only demonstrates that the nation’s top scientists are developing new research techniques by harnessing the power of informatics, but also how healthcare has become a larger priority as economic pressures make cost-cutting a necessity.
The first group of projects, announced last year, concentrated on a variety of topics including data science education, biomedical research, geology and national security. While some of those topics make appearances in this year’s round, too, healthcare big data clearly is a top priority.
Some of the highlights:
- CancerLinQ: A public-private consortium of the American Society of Clinical Oncology, vendors, foundations and government is creating analysis tools to find new cancer treatments using deidentified data of all cancer patients instead of the identified data of the 3% of cancer patients currently enrolled in clinical trials. The $80 million project will go live with analysis tools for clinicians as early as 2015 if all goes according to present timetables.
- Clinicaltrials.gov update: Novartis, Pfizer and Eli Lilly and Company are partnering with the federal government to open up access to clinical trials data for the benefit of recruiting patients to trials. Other tools will make trials searchable for patients. The idea is to provide more detailed, patient-friendly information about trials, including a machine readable “target health profile” to improve the ability of healthcare software to match individual health profiles to applicable clinical trials. Furthermore, patients will be able to search for trials using their Blue Button downloadable health data. The 2014 launch will include 50 clinical trials in its database, and other sponsors of clinical trials may participate.
- Our Health Data Cooperative: A patient-owned database, this tool espouses to give patients more control over their health data. Subscription fees paid by healthcare organizations for access to deidentified data will fund the project, along with $12 million in federal monies to promote patient enrollment. The database will be built by The School of Information and Library Science at the University of North Carolina at Chapel Hill and the Center for the Advancement of Health Information Technology at RTI International, and goals include enrolling 10 million U.S. residents in the next 24 months.
View the full list here.
November 12, 2013 12:31 PM
Posted by: adelvecchio
, medical device regulation
, medical devices
Electronic health record developers want health IT that isn’t currently regulated as a medical device to remain that way, pending further review from the FDA, FCC and ONC. The HIMSS Electronic Health Record (EHR) Association, a group that represents more than 40 EHR companies, expressed their opinion in a letter addressed a letter to HHS Secretary Kathleen Sebelius. The letter read that regulation “beyond what is currently in place is not appropriate until further analysis of data and the establishment of a risk-based framework have been completed.” The EHR Association letter was a response to HHS’ cooperation in creating a regulatory framework for medical devices as suggested by the FDA Safety and Innovation Act (FDASIA) Workgroup.
The Health IT Policy Committee approved FDASIA’s draft recommendations for the regulatory framework, which were presented in September at a workgroup meeting. The workgroup’s recommendations will be turned over to the FDA, FCC and ONC. Those three agencies will then develop a final report “on an appropriate, risk-based regulatory framework pertaining to health information technology including mobile medical applications that promotes innovation, protects patient safety, and avoids regulatory duplication.” Additional regulation of health IT beyond current standards is not necessary, according to FDASIA’s report.
The EHR Association’s letter disagrees with an FDASIA idea under consideration that health IT not regulated as medical devices should be labeled “class 0″ medical devices by the FDA. The association’s letter states that such a “formal, regulatory approach” to health IT is not warranted. The invention of a “class 0″ for medical devices would add a level beneath the least-regulated class I devices. Class I devices include things such as mHealth applications, hospital beds and dialysis chairs.
The FDA recently released its final rule for a unique device identification system for medical devices. The rule requires every medical devices model to have its own unique ID number, for tracking and security purposes. The rule also necessitates the creation of a public database of all medical devices. The rule was established to better organize and identify problems with specific devices.
November 5, 2013 12:01 PM
Posted by: adelvecchio
, ICD-10 conversion
, ICD-10 pilot
Providers deep in preparation for the ICD-10 changeover may want to take note of a recent report which summarized the outcomes of a preliminary ICD-10 test and found coders have a way to go before they’ll be ready for the upgrade. The ICD-10 National Pilot Program was a joint project carried out by HIMSS and the Workgroup for Electronic Data Interchange (WEDI). The average accuracy of the coders included in the study was 63%. Confusion between the number “0″ and letter “o” and the number “1″ and letter ‘l” were among the most commonly observed coding errors.
The ICD-10 pilot was established by HIMSS and WEDI to “raise awareness around ICD-10 testing, possible testing methods and provide information on the outcomes of a specific collaborative pilot testing program.” It also aimed to identify common problems, such as number/letter mix-ups, so providers could avoid them when transitioning from ICD-9. The study was representative of the top 100 to 200 most common medical conditions. Coding accuracy for specific conditions ranged from 29% to 100%.
Studying the results of the HIMSS/WEDI ICD-10 pilot should be a small part of providers’ plans for a smooth coding transition. Some experts recommend hiring a project manager to oversee the coding changeover and to occasionally review ICD-10 compliance. Providers should also be careful in measuring their ICD-10 transition by budget goals. Though they may stay within their targeted budget, it doesn’t mean the goals that keep the project on schedule are being met.
The level of specificity and vast jump in number of codes in ICD-10 compared to ICD-9 is responsible for much of the concern with the impending transition. However, the increase in codes from 14,000 to 150,000 should make coding easier and less complicated according to a CMS ICD-10 fact sheet. The more detailed codes in ICD-10 will certainly lead to more accurate documentation of conditions and procedures, though it remains to be seen how quickly coders can adjust to the new standard.
October 29, 2013 1:01 PM
Posted by: adelvecchio
, EHR implementation
, patient engagement
With meaningful use stage 2 deadline bearing down on providers, the use of EHRs is changing how patient information is viewed and transferred – an issue that is explored in detail in a recent ONC study. Nearly one-third of physicians shared patient clinical summaries with other providers in 2011, according to the ONC study published in the American Journal of Managed Care. In that same year, the majority (55%) of 4,326 responding office-based American physicians had the capability to send prescriptions electronically.
“As Stage 2 of Meaningful Use moves forward, it will be important to continue monitoring physicians’ exchange capabilities and actual exchange activity to ensure that health information follows the patient wherever they go,” said Vaishali Patel, an ONC senior advisor and lead author of the study, in a release announcing the ONC’s study.
Providers who implement EHR systems often do so with incentive payments and patient engagement in mind. But a recent Xerox study revealed that many of today’s patients have been slow to embrace electronic records. The study, completed earlier this year, showed that only 32% of patients want their records converted to electronic forms, an increase of 6% from 2010. Comparing the two studies indicates there is a gap between patients and providers regarding the availability of electronic medical services. Only 19% of American adults have access to their online medical records.
Not all EHR systems can effectively communicate with one another, something that many in healthcare hope to change by encouraging interoperability. Some predict that the number of providers sharing patient information with other providers will increase only slowly in the next few years because of the lack of business incentives behind making that change. The fragmented nature of the healthcare system as a whole is another force holding interoperability back. Some HIPAA claims data, less complicated than EHR clinical data, took more than 15 years to become standardized.
October 22, 2013 11:25 AM
Posted by: adelvecchio
Affordable Care Act
, health insurance exchange
After weeks of confusion and a multitude of errors affecting user experience on the Healthcare.gov health insurance exchange website, the government has laid out a plan to address the most common bugs. Users have had issues both signing up for the site and logging in to their accounts once they’ve registered. An HHS blog post dated October 20 identifies high traffic numbers as contributing to the site’s malfunctions. There have been more than 19 million unique page views on the site since it opened on October 1. In that same timeframe, nearly 500,000 applications for insurance coverage have been submitted.
The registration numbers exceeded the government’s expectations from the first day of enrollment. The site had more than 8 million users within the first four days and experienced a high of 250,000 visitors in a minute, which was four times greater than the expected traffic highpoint.
In a public address, President Barack Obama weighed in on the site’s performance issues saying it’s “not working the way it should for everybody — there’s no sugar-coating it.” The Administration said Sunday that they are involving government and private computer experts to rewrite code and fix other problems plaguing the site. By assembling a team and publicly acknowledging the site’s failings, the government may be revealing that the problems extend beyond basic front-end registration issues.
Cloud computing may have helped the site more effectively handle the high load of traffic it attracted. Cloud resources can be scaled to accommodate larger crowds, something Healthcare.gov’s outdated infrastructure wasn’t designed to handle. Expert analysis uncovered that cloud services do comprise a small part of the site’s design and support system, but its overall infrastructure suggests the site’s failing started early in development and was caused in part by the inclusion of too many data centers.
October 15, 2013 2:19 PM
Posted by: adelvecchio
, Patient review
, physician review
Industry-wide opinion about how much, if any, say patients should have in the care process is largely unsettled. However, according to a recent ZocDoc survey, most physicians are aware of the feedback patients leave in online reviews of their care. The study said 85% of respondents “proactively monitor online reviews about themselves.” More than half of physicians (62%) found their reviews overall to be “fair,” ranking them somewhere between four and seven out of 10.
Though a high percentage of physicians admit to viewing patient critiques, other data suggests they don’t put much stock in patients’ post-care opinions. A study from the American College of Physician Executives revealed that only 12% of physicians thought such review sites were helpful and should be made more widely available to patients. On the flip side, 26% of respondents agreed that patient review sites are a “nuisance that provides no benefit.”
Some hospitals are moving ahead with taking patient feedback into consideration, regardless of how individual physicians feel about the practice. The University of Pennsylvania Health System recently completed a three-month pilot with a patient feedback program, at the conclusion of which it signed a multiyear contract to use the program in their facilities. The service is called Yorn, which stands for “your opinion, right now,” and allows patients to send messages directly to hospital staff via smartphone or other devices.
The trend of review sites has caught on outside the U.S., with India experiencing particularly strong adoption. India has seen a reduction in family physicians and a rise in private practitioners, resulting in more patients looking for trusted physicians. A popular patient review site, suggestadoctor.in, has more than 2,000 reviews. The site is unique because it allows patients to post their experiences and also lets physicians respond to any negative reviews, a feature that may become common if more facilities take Penn Medicine’s approach and integrate patient feedback into their care processes.
October 8, 2013 12:27 PM
Posted by: adelvecchio
Defense Health Agency
, integrated EHR
, legacy EHR systems
The U.S. Department of Defense (DoD) is now considering a replacement to its legacy EHR systems with an off-the shelf product that is compliant with at least stage 1 of meaningful use. The department is currently performing market research to assess the products that might suit their needs. They are interested in EHRs that have been evaluated by third-party research firms and have been recognized by users as easy to learn and use.
The DoD and Department of Veterans Affairs (VA) have been tasked with developing a shared integrated electronic health record system (iEHR), which must be completed by Oct. 1, 2016 as mandated by the National Defense Authorization bill. The DoD is considering Veterans Health Information Systems and Technology Architecture (Vista) EHR options during their replacement process. Vista is an “automated environment that supports day-to-day operations at local Department of VA healthcare facilities.” Adoption of a Vista EHR system by the DoD would bring the two agencies closer to realizing their iEHR.
This isn’t the first detour in the DoD’s road to a unified EHR. Their $2 billion, 13 year “EHR Way Ahead” project was determined to be insufficient, according to a 2010 report issued by the Government Accountability Office. The system, formally known as the Armed Forces Health Longitudinal Technology Application, was planned to rollout in four blocks. Only one of those blocks was fully deployed, while the second was released in part, and the final two blocks were removed from the project. The project also failed to meet its targeted finalization date in 2007.
Healthcare for military personnel underwent another recent change with the establishment of the Defense Health Agency. The agency plans to streamline care among the military branches and will manage the health plans of the 9.6 million beneficiaries of TRICARE military coverage. An estimated 500 Army, Navy and Air Force workers, predominately IT staff, have already begun working for the new agency which will oversee “the operational work for health information technology, medical logistics, pharmacy operations and facilities planning for the services.”