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    Despite the fact that 96 percent of hospitals and 78 percent of physician practices have adopted certified health IT — too many hurdles still stand in the way of progress, according to ONC’s “Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information”—the agency’s annual report to Congress mandated under the HITECH Act.

    The report found that:

    • Despite HIPAA, patients still lack the ability to access health data and that makes it harder to manage their health and shop around for medical care
    • Providers also lack access to patient data at the point of care, particularly true when patients see multiple doctors
    • And payers often lack access to clinical data about populations of covered individuals

    WHY IT MATTERS

    Today’s certified health IT products lack secure access and sharing of data — like that found in other industries — the kind of capabilities needed to allow for greater innovation, the report says. ONC is eager to see seamless data flow, to accelerate progress.

    THE BIGGER TREND

    ONC has known that interoperability has been the sticking point for years and thus changed its focus from meaningful use of EHRs to a greater emphasis on data sharing. The average hospital has 16 electronic medical record platforms across various facilities, which helps to explain some of the difficulty. Some are even still using faxes to exchange information, a December ONC report said.

    One potential solution is opening up, however. A December report issued by KLAS says more healthcare organizations should join the newly launched CommonWell-Carequality network. Many EHR and health IT vendors have eliminated obstacles to participation in the data-sharing network, going so far as to make it plug-and-play. But, what’s holding them back is governance and organizations themselves dragging their feet on participating in new national interoperability frameworks, such as the CommonWell-Carequality link.

    "Even Epic and athenahealth customers report diminished value from their connection when local exchange partners opt not to connect to the national networks," according to the KLAS report on interoperability. "Until other vendors take an opt-out approach, you as an organization will have to be proactive in promoting local connections to these networks to ensure high value from your connection."

    Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology. 

    Twitter: @Diana_Manos
    Email the writer: dnewsprovider@gmail.com 

    Healthcare IT News is a HIMSS Media publication. 


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    The agency’s Annual Report 2017–18 identified that “42 data breaches (in 28 notifications) were reported to the Office of the Australian Information Commissioner (OAIC)… concerning potential data security or integrity breaches”, but with “no purposeful or malicious attacks compromising the integrity or security of the My Health Record system”.

    Of the 42 instances, one breach resulted from unauthorised access to a My Health Record as a result of an incorrect parental authorised representative being assigned to a child.

    Two breaches resulted from suspected fraud against the Medicare program, where the incorrect records appeared in the My Health Record of the affected individual and were viewed without authority by the individual undertaking the suspected fraudulent activity.

    The ADHA report also identified that 17 breaches were a result of data integrity activity initiated by the Department of Human Services to “identify intertwined Medicare records (that is, where a single Medicare record has been used interchangeably between two or more individuals)”.
    The remaining 22 breaches were from suspected fraud against the Medicare program involving unauthorised Medicare claims being submitted, and the incorrect records appearing in the My Health Record of the affected customers.

    An ADHA spokesperson confirmed that in all instances, the Department of Human Services took action to correct the affected My Health Records.
    “Errors of this type occur due to either alleged fraudulent Medicare claims or manual human processing errors, as was the case for the breaches reported during the 2017-2018 financial year. There has been no reported unauthorised viewing of any individual’s health information from a notifiable data breach,” the spokesperson said.

    “In each case, the affected individuals have been contacted and the OAIC has examined the circumstances of the breach and no unauthorised breach has been determined.”

    The ADHA spokesperson added that there are more than 6.3 million people with a My Health Record, but in the six years of its operations, there have been “no reported unauthorised views of a person’s health information”.

    “When a person’s health information is stored in different places – hospitals, doctors’ offices, filing cabinets, computers – they don’t know who is accessing it or when. In a My Health Record, every access is listed in a person’s record access history. A person can be notified by text message about who is accessing their record or restrict access to all or parts of their record,” the spokesperson said.

    On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division.
     
    The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time.

    “At the time of writing, almost one quarter of all Australians have registered for a My Health Record. That figure is expected to change dramatically with the transition to an opt out system early in the 2018–19 financial year,” ADHA CEO Tim Kelsey said in the report.

    “Once this resource becomes almost ubiquitous across the Australian health system, clinical workflows and consumer behaviours will gradually and irrevocably change to take advantage of its many benefits.

    “For many people the benefits of digital health will be realised gradually, as health and medical data gradually accumulates to form a comprehensive medical history,” Kelsey said.

    This article first appeared on Healthcare IT News Australia.


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    HCA Healthcare's Physician Services Group offers oversight for some 5,700 physicians and advanced practice providers, and embraces an approach to communication and collaboration that's "deeply collaborative," said Barbara Coughlin, RN, vice president of quality at HCA.

    One specific area where the health system has been making big headway in that regard has been an all-hands-on-deck response to the opioid crisis.

    "The opioid abuse epidemic has ravaged communities across our nation, claiming the lives of more than 115 Americans every day," said Coughlin.

    "Across the PSG organization, we recognize that there is a real opportunity to make a meaningful difference, and doing that requires data, partnership, and a commitment to making these efforts a priority," she explained. "We have been very intentional with how to mitigate the effects of the epidemic our nation faces."

    At HIMSS19, Coughlin and her colleague Carol White, ambulatory EHR medication management pharmacist at HCA, will show how the health system has been making use of its data to ensure its providers are thinking critically about the way they prescribe controlled substances.

    Their session will explain how HCA Healthcare and the PSG is leveraging its technology infrastructure to help physicians stay compliant with regulations while also delivering better and safer care to complex patient populations.

    They'll show how they define key performance indicators of effective pain management programs, tap into data analytics and reporting to keep tabs on how providers are prescribing and  gain insight into specific EHR workflows to learn how physicians make decisions about pain management therapy.

    In early 2013, the PSG "developed, in partnership with our physicians and providers, controlled substance guidelines that outline best practices around controlled substance prescribing," Coughlin explained. "Included in these recommendations is monitoring of state prescription drug monitoring programs, implementing controlled substance agreements with patients, and random drug screens, if necessary."

    When that work began, "much of our initial activities were manual," she said. But by the next year, HCE began working more closely with IT staff and EHR leadership to "identify and develop ways to aggregate prescribing metric data and make it available to our providers."

    That ability to see and learn from the physicians' prescribing patterns is "powerful," said Coughlin. "We evaluate this data on a routine basis to help ensure we are within appropriate national benchmarks and to continually identify opportunities to improve."

    "Having this data available for our providers was a turning point," added White. "It made the data transparent and actionable. This has been a big win for our prescribers and, more important, for our patients. And, it allows our providers to have robust conversations with patients regarding the care that we ultimately want to deliver."

    Coughlin and White's presentation, "A Quality and Analytics-Based Approach to the Opioid Epidemic," is scheduled for Wednesday, February 13, from 8:30-9:30 a.m. in room W303A.

    HIMSS19 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS19 global conference in Orlando.

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com

    Healthcare IT News is a publication of HIMSS Media.


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    The Office of the National Coordinator for Health IT (ONC) has issued its latest report on interoperability standards, following the close of comments last October 1. ONC officials said they received 74 comments on the ISA this year, resulting in nearly 400 individual recommendations for revisions.

    The 2019 Interoperability Standards Advisory Reference Edition (ISA), which includes recommendations from the federal Health IT Advisory Committee and changes made due to the comments from stakeholders, contains new standards and updated characteristics and calls for more efforts to make e-prescribing easier. It also encourages a more prolific patient record exchange between patients and their many care providers. The ISA is updated throughout the year for substantive and structural changes, based on ongoing dialogue, discussion, and feedback from stakeholders, ONC says.

     

    The ISA represents ONC’s “current assessment of the heath IT standards landscape,” and ONC officials note it is for informational purposes only. “It is non-binding and does not create nor confer any rights or obligations for or on any person or entity,” ONC said.

     

    WHY IT MATTERS

    ONC listened. “Since the 2018 comment period on the Interoperability Standards Advisory (ISA) closed on October 1, we combed through all your comments and made improvements based on your suggestions, write Steven Posnack, Chris Muir and Brett Andriesen in a Jan. 14 blog.

    The latest changes to the reference manual itself include RSS feed functionality to allow users to track revisions to the ISA in real-time; shifting structure from lettered sub-sections to a simple alphabetized list; and revised titles to many of the interoperability needs, to reflect their uses and align with overall ISA best practices.

    ONC also added more granular updates on added standards, updated characteristics, and additional information about interoperability needs.

    THE BIGGER TREND

    The Interoperability Standards Advisory (ISA) process is traditionally how ONC coordinates the identification, assessment, and public awareness of interoperability standards and implementation specifications, encouraging all stakeholders — clinical and research — to use them. ONC also encourages pilot testing of the standards.

    Starting with the 2017 ISA, the ISA’s focus expanded to more explicitly include public health and health research interoperability. The ISA is not exhaustive, ONC says, but it is expected to be incrementally updated to include a broader range of health IT interoperability needs.

    To provide the industry with a single, public list of the standards and implementation specifications that can best be used to address specific clinical health information interoperability needs. Currently, the ISA is focused on interoperability for sharing information between entities and not on intra-organizational uses. 

    Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology. 

    Twitter: @Diana_Manos
    Email the writer: dnewsprovider@gmail.com 

    Healthcare IT News is a HIMSS Media publication. 


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    Quality improvement is no longer just a nice-to-have. It's a critical must-do for any health system that hopes to survive in the era of value-based care. But opinions vary widely on the best way to manage data for better outcomes.

    Robert Altemose, RN, clinical operations analytics director at Altamonte Springs, Florida-based AdventHealth (which until this past August was known as Adventist Health System) explains, doing so retrospectively isn't effective – true quality improvement has to be done proactively and in real time.

    At HIMSS19, in a presentation with his colleague, Judi Reed, senior manager of clinical operations analytics and user experience at AdventHealth, Altemose will show how his team has helped the health system make the leap from retrospective to real-time analytics, nudging its clinical staff toward higher-quality care as it's delivered.

    They'll show how AdventHealth got buy-in from top leadership and the clinicians in the trenches, combined new technologies with its existing IT infrastructure and designed efficient and effective dashboards to bring analytics to the bedside.

    First things first: "Leadership engagement is key to the deployment and effective use of real-time analytics," said Altemose. "Without analytics of this kind being driven from the top down there is no impetus for the front-line users to engage."

    In addition, for those clinical end-users, "it is best for processes to be as standardized and as well defined as possible prior to building a real time analytics platform," he explained. "However, it is not a prerequisite for success. Real-time analytics, when properly built, tend to quickly identify where a process breaks down or has not been followed."

    But the "most important aspect of successfully leveraging real-time analytics is metric selection," said Altemose. "When deciding on what to include there isn't much value in exposing metrics that cannot inspire action."

    At AdventHealth, for example, "I handpicked metrics that allow clinicians to take action before there is a negative impact to the patient and left anything that was classified as 'good to know' on the cutting room floor," he explained.

    And what should be the bigger emphasis in projects such as these? People or technology?

    "Neither can function independently," said Altemose. "The staff needs to be engaged in using the tool for the organization to realize the value the application can provide. However, if the application is difficult to use, requires a lot of work to find the actionable items, or is filled with metrics that don't drive change then there can be no improvements. Both must work in concert to maximize the value the tool can bring."

    Indeed, buy-in from docs and nurses is non-negotiable for effective real-time analytics, which "cannot be successful without clinician involvement," he said. "Feedback from the end users and process owners throughout the design, and building phases is an absolute must. Continuing to listen following go-live is also necessary for continued success."

    That said, however, there is a also "a significant risk of analysis paralysis," Altemose warned. "A strong, politically savvy, application owner is necessary to ensure that only the content with the greatest opportunity for having the most impact is included."

    At AdventHealth, the clinical ROI of real-time data is already showing itself.

    "This application has impacted CLABSI scores, CAUTI scores, as well as flu vaccine and pneumo vaccine compliance rates," said Altemose. "These are all metrics that impact a hospitals CMS Star rating and we have seen improvements in our star ratings as well."

    Altemose and Reed's presentation, "Using Real-Time Analytics to Improve Patient Clinical Outcomes," is scheduled for Wednesday, February 13, from 4-5 p.m. in room W206A.

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com

    Healthcare IT News is a publication of HIMSS Media.


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    Application programming interfaces are all the rage in healthcare and just about every other industry undergoing digital transformation. And with the release of Health Level 7’s Fast Health Interoperability Resources 4 earlier this month, the excitement around open APIs, FHIR and data interoperability just kicked into a higher gear.

    “Increasing the use of APIs could represent a dramatic shift in how health data is accessed, extracted, and utilized to improve patient care. APIs can help get patients their data, support information exchange among healthcare facilities, and enable enhanced clinical decision support tool,” said Ben Moscovitch, project director of health information technology at Pew Charitable Trusts.

    Indeed, the 21st Century Cures Act gives the Office of the National Coordinator for Health IT the opportunity to advance standards around open API, FHIR included, and to encourage vocabularies and code sets for clinical concepts, Moscovitch added, while the private sector has been making strides of its own.

    Consider the Argonaut Project, CommonWell Health Alliance and Carequality, which last year reached an interoperability milestone of sorts when the organizations made their connectivity live nationwide such that healthcare facilities that belong to either can now bilaterally exchange CCDs with any other participating member.

    Yet, obstacles remain. The industry continues awaiting information blocking rules from ONC, for instance, and the agency is working on draft regulations outlining requirements for APIs that are expected to ease the exchange of health data.

    “ONC should not miss this opportunity to advance the effective use of APIs, such as by ensuring that more data are exchanged, appropriate standards are used, and longitudinal data are made available, among many other steps,” Moscovitch said.

    Finalizing the rules is one thing, of course. Hospitals, health systems, payers and other entities still have to put them to use.

    “For APIs to reach their full potential,” Moscovitch said, “industry and government should ensure that APIs can access more patient information, and work to begin breaking down other barriers that hamper them being able to effectively share data.”

    Moscovitch, along with Jeffrey Smith, vice president of public policy at the American Medical Informatics Association, will offer more insights at HIMSS19 during a session titled “Unlocking EHRs: How APIs usher in a new data change era.” It’s scheduled for Wednesday, Feb 13, from 1:00-2:00 p.m. in room W303A.

    HIMSS19 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS19 global conference in Orlando.

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com 

    Healthcare IT News is a HIMSS Media publication. 


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    Sponsored: Alleviating the global problem of physician burnout

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    Electronic health records are very good at being repositories for valuable patient data. But they need help when it comes to putting that data to work for more innovative care delivery. The ever-expanding volume and variety of clinical and social-determinant factors will require more advanced technologies to be optimally harnessed for precision medicine.

    Enter AI and machine learning, which "will play a growing role in healthcare, under two main categories – generating knowledge and processing data," said Auckland, New Zealand-based Kevin Ross, who will speak next month at HIMSS19.

    Ross is general manager at Precision Driven Health, launched as a partnership between Orion Health (where he is director of research) and government agencies and academic organizations in New Zealand to explore and promote precision medicine. He sees machine learning as a key enabler in the years ahead as health systems look to unlock the data and in their EHRs and put it to work for more personalized care.

    "Health records have been electronic – and therefore accessible for analysis – for a relatively short period of time, but we are now seeing huge volumes of data being generated from different sources," he explains. "We've had insufficient computational power to process the volume of data in a genome, let alone a microbiome, etc. until fairly recently."

    The advent of AI and machine learning opens new avenues for healthcare wisdom to be accrued. Medical research has traditionally come through "targeted studies on narrow subsets of the population," he said, "now we can analyze over large populations in relative real time, because the data is being collected digitally. New knowledge will come about by applying machine learning to these increased data sets to uncover patterns that are occurring today without being noticed."

    In Orlando, Ross will explain how he and other researchers are making the most of some unique aspects of New Zealand's healthcare landscape – connected electronic healthcare data across the population, leading-edge research organizations – to enable the development of new technologies and data strategies for precision medicine.

    "New Zealand has some unique benefits, including a long history of digital health records with well managed health ID numbers, so it is a lot easier to link different data sets together," he explains. Add to that :

    • Linked data between social services (health, education, justice, welfare, tax) available for research purposes;
    • A single payer system whereby the incentive of patient, provider, and system are typically well aligned (e.g. early intervention benefits all)
    • Willing collaboration between commercial and public provider organizations as well as between clinical and data science researchers
    • A unique ethnic diversity (74 percent European, 15 percent Maori, 12 percent Asian, 7 percent Pacific Islander – including those identifying multiple)
    • A strong data science research community
    • A population relatively comfortable with technology and with broad access

    All that, plus the fact that New Zealand has a smallish population (fewer than 5 million people) means that "research is more likely to be population wide rather than highly specialized," said Ross.

    From that remote corner of the globe to other health systems worldwide, he sees a big future ahead for AI-enabled EHRs – enabling a fast evolution for precision medicine.

    "Machine learning can be used to aid intensive tasks such as processing large data sets for genomics, image processing or network analysis, as well as finding anomalies – such as for diagnosis or fraud detection – and identifying cohorts," he said. "There are interesting applications in maintaining records such as matching data from different systems, inferring missing data elements."

    And as the evolutions continue apace, what should health systems who have already begun AI implementations be doing to ensure they're making best use of machine learning in their workflows?

    "Design systems with a view to interoperability and data sharing," said Ross. "Use standards, build tagging into systems. And make it easy for patients to control the use and sharing of their data, and see the benefits from it."

    In addition, he advised health systems to make the most of all the data they have on hand: "Even 'dirty' data can have incredible predictive value," he said. "Don't wait for perfect data to start using it."

    Ross' presentation, "Machine Learning Over Our Growing Electronic Health Records," is scheduled for Wednesday, February 13, from 2:30-3:30 p.m. in room W308A.

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com

    Healthcare IT News is a publication of HIMSS Media.


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