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The EHR Interoperability Challenge - an interview, an overview

The EHR interoperability challenge is what stands between a physician's ability to look up, extract, and track a patient's medical activities and records at medical sites other than their own. This could be at a laboratory where a patient's specialty blood work is being analyzed or they're having surgery on an inpatient or outpatient basis.


When it comes to tracking these patients, it's literally as they move about in the sphere of the healthcare world. The interoperability challenge occurs because you need your EHR to talk to systems outside your practice.


Solving this challenge means maintaining continuity of care for patients, minimizing or eliminating the duplicity of services, and helping physicians share patient information so they can gain insight from specialists that would complement their diagnoses.


Many EHR companies aren't willing to share access to their systems unless a physician is part of their overall user base. If you work in a particular hospital or practice that has their product, these particular companies will share information with physicians. The problem is they won't work with peripheral players, or physicians who are unaffiliated with the hospital or practice where their EHR is installed.


Why is it in the hospital's interest to provide access to patients via their EHR?


Sharing access to patients via the hospital's EHR creates a win-win situation where the hospital can keep the patient in their system.


these are excerpts from an interview David Wasserman, an advisor with the practice solutions and medical economics group at the Massachusetts Medical Society.


read more at the original


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Should Physicians Tailor Patient Engagement Based on Age?

Should Physicians Tailor Patient Engagement Based on Age? | healthcare technology |

New patient engagement trends from TechnologyAdvice Research reveals digital engagement is a growing factor in how patients choose healthcare providers.

Quality of care has long been a primary factor in choosing a healthcare provider, but convenience and communication are also becoming key considerations for patients. Still, many physicians do not appear to be offering the digital engagement services that can meet those demands.

According to a new nationwide survey conducted by TechnologyAdvice Research, a majority of patients (60.8 percent) said digital services like online appointment scheduling and online bill pay are either “important” or “somewhat important” when choosing a physician. However, when asked what services their current physician provides, less than one-third of patients indicated they have access to either online bill pay, online appointment scheduling, or the ability to view test results and diagnoses online, which are the top three services that patients report wanting the most.

“Primary care physicians are reporting some of the highest rates of EHR adoption to comply with government regulations and to receive incentives from Meaningful Use, but a significantly lower number of patients claim to have access to these patient portal services,” said TechnologyAdvice Managing Editor Cameron Graham, who authored the survey. “The issue here may not be implementation of digital services, but instead a lack of patient awareness. If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”


- If providers wish to gain an upper edge in attracting new patients (especially younger ones), and in retaining their existing patients, they should invest in a fully featured patient portal system. For many primary care physicians this should not be difficult. Most comprehensive EHRs include patient portal features, and dedicated patient portal vendors are making strides in integrating with third-party systems. In particular, prioritizing systems with intuitive online appointment scheduling, online bill pay functionality, and online test results could provide a significant draw for new patients. 

- For practices that already have patient portal systems, they should dedicate resources to making sure their patient populations are informed of the existence of such services. They should also consider prominently featuring these services in their advertising and on their websites. When orienting new patients to their practice, providers need to have a plan for walking patients through the initial portal set-up requirements and making sure they understand the features available to them.

-For particularly tech-savvy practices, a dedicated smartphone app could help set them apart, and attract younger individuals. 

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Why Behavioral Health Acutely Needs EHRs

Why Behavioral Health Acutely Needs EHRs | healthcare technology |
Legislation that incorporates psychiatric care into the acute-care spectrum and extends EHR incentives to behavioral health facilities has been proposed for going on five years now.

A show of hands: Who believes depression or bipolar disorder have no impact on the severity and treatment of a patient’s diabetes and COPD?

It’s an idea no practicing physician would support.

Yet time and again, we act as though mental illness and care can be kept separate from physical ailments.

Take Meaningful Use (MU), for example. The federal government believes healthcare must move into the digital age and is willing to pay hospitals to buy computer systems and electronic health records (EHRs).

But the financial rewards of demonstrated MU only extend to acute care hospitals and clinics, not psychiatric facilities, as though human health can be partitioned and compartmentalized.

While treating patients holistically has been accepted clinically for decades, some behavioral health advocates are turning up the pressure now to finally also bring behavioral health IT into the digital age. 

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Jason Traver's curator insight, February 16, 2015 5:40 PM

A consultant's perspective on Behavioral Health. Pushing Behavioral Health past the red tape in EHR to drive improvements in care.

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Standardization vs. Personalization: Can Healthcare Do Both?

Standardization vs. Personalization: Can Healthcare Do Both? | healthcare technology |

Can we standardize and personalize healthcare at the same time? James Dias, CEO and Founder of Wellbe shares how we can do both to improve patient care.

Usually when personalization is mentioned in the world of healthcare thoughts jump to genetics and personalized medicine with custom cancer drugs and medical devices. However, there is another type of personalization that can be applied to healthcare, to make each patient feel like an individual, rather than just “one of the masses.”

The world of ecommerce discovered the value of personalized online experiences a decade ago and the additional revenue/branding/loyalty that can be generated from it. For example, the NikeiD website offers customers the ability to customize their own shoes. Who can forget the “Elf Yourself” campaign from Office Depot, where you could stick your friends’ and family’s faces on to happy dancing elves? With the new year upon us, fewer people are opting to buy regular old glossy calendars when a dozen photo sites will let you make a custom one from your personal photos.

Personalization is all around us, from the recommendation engines of Netflix and Amazon, to the custom radio stations you can create on Pandora. Smart programs have figured out what’s relevant to each of us and help filter the signal from the noise in today’s massive universe of information. As consumers, we engage and respond much more positively to these personalized experiences, which encourages loyalty and repeat business.

The psychology of personalization shows that engaging the customer in the process helps build a psychological and emotional attachment to their purchase. In addition, increasing customer participation boosts feelings of control and ensures satisfaction at the point of sale.

Similarly, by offering a personalized digital healthcare experience, we can increase patients’ ownership of their health and outcomes. Often it seems that patients feel they have no control over their outcomes, when actually the opposite is true. When they feel like active participants in their health journeys, it is more likely they will achieve the outcomes they desire, and they will feel like they got better value for their dollar.

Inforth Technologies's curator insight, January 21, 2015 9:12 AM

We have been preaching personalizing the NextGen EHR for years.  Not just personalization for patients, but for physicians and their practices.

AAAASF Marketing's curator insight, January 21, 2015 11:40 AM

"As consumers, we engage and respond much more positively to these personalized experiences, which encourages loyalty and repeat business."

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Desire For Portals Spans Generations

Desire For Portals Spans Generations | healthcare technology |

Millennials and Baby Boomers alike want more from their EHR, especially access through portals.

Last year’s annual EHR survey from Xerox found patients desired more information on EHRs and thought their providers should give more EHR education. This year, Xerox reports their 2014 annual EHR survey finds patients desire access to their records through portals - and it’s not just younger patients who are looking for digital access.

Health Data Management reports about a third of patients said simple knowledge of portals was lacking. Of those who said they did not use portals, 35 percent did not even know a portal was available and 31 percent said their physician had never spoken to them about portals.

A second study by Technology Advice found 40 percent of patients don’t know if their provider offers an online portal, even though a third study showed simply taking to patients about portals increases their use.

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Best EHR systems of 2014: Physicians rank 5 key performance areas

Best EHR systems of 2014: Physicians rank 5 key performance areas | healthcare technology |
The performance of an electronic health record (EHR) system can mean the difference between a thriving practice and a struggling one. These systems impact every aspect of medical care, from the car

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EHRs And Disease Prediction

EHRs And Disease Prediction | healthcare technology |

Much of the chatter around electronic health records (EHRs) revolves around efficiency and cost cutting in clinical practice. There is even a bit of discussion about the use of EHRS to improve population health. But is there more benefit to be found in individual patient health?

Perhaps the greatest potential of the EHR, (and the concept applied to a broader application, the EMR) lies in the role it can play in predicting clinical outcomes around a range of diseases and conditions.

This application is still very much in its fledgling stage, but here are just a few examples of how data analytics, when applied to EHRs in mindful ways, can bring about positive changes in patient health.

Predicting Sepsis

One of the most recent examples we saw came out of UC Davis. Researchers there found that, by compiling and analyzing routine information — blood pressure, respiratory rate, temperature, and white blood cell count — as pulled from EHRs, they were able to predict early stages of sepsis, a condition that is a leading cause of hospitalization and death in the U.S. It took them only three measures — lactate level, blood pressure, and respiratory rate — to calculate the likelihood that a patient would die from the condition.

Progressing Kidney Disease

Data from EHRs has also played a key role in predicting the need for dialysis after a patient with chronic kidney disease progresses into kidney failure.

The Journal Of The American Medical Association in 2011 studied patients who were referred to nephrologists between April 1, 2001, and December 31, 2008, in an effort to develop and validate predictive models for the progression of chronic kidney disease.

According to the study, “Our models use laboratory data that are obtained routinely in patients with CKD and could be easily integrated into a laboratory information system or a clinic EHR.” It also notes that emerging literature suggests that the methods lead to “improved patient outcomes with individualized risk prediction and with advances in information technology that allow for easy implementation of risk prediction models as components of EHRs.”

All data for the study where pulled from nephrology clinic EHRs.

Cardiovascular Risk

EHRs have also been used to improve cardiovascular risk prediction. A study (available from the National Institutes Of Health), analyzed whether internal EHR data (using flexible, adaptive statistical methods) could improve clinical risk prediction. The study used the fact that EHRs have been extensively implemented in the VA system as an opportunity for exploration.

It found that, “despite the EHR lacking some risk factors and its imperfect data quality, health care systems may be able to substantially improve risk prediction for their patients by using internally developed EHR-derived models and flexible statistical methodology.”

Controlling Hypertension

Another prevalent health issue in the U.S., hypertension, has seen researchers apply predictive analytics using EHR data to gain more insight into the disease. This study, from the Journal Of Informatics In Health And Biomedicine, sought to identify transition points at which hypertension is brought in, as well as pushed out of, control, through the use of EHR data.

The study of 1294 patients with hypertension (who were enrolled in a chronic disease management program at the Vanderbilt University Medical Center) found that accurate prediction of transition points from a control status could be achieved

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EHR Analysis More Effective, Cost Efficient Than Clinical Trials

The use of electronic health records to identify the best treatment option for patients is more efficient and less costly than the current clinical trial process, according to a study published in the journal Health Technology Assessment

Study Details

For the study, which was funded in part by the National Institute for Health Research and the Welcome Trust, researchers from several universities in the United Kingdom, used a new computer program in 23 approved general practitioners across England and Scotland.

The first part of the study used 300 patients' electronic health records, which are stored in the Clinical Practice Research Datalink and updated during routine medical visits, to monitor the effects of their prescribed treatments.

A second part of the study, which involved 31 participants, looked at the use of antibiotics among patients with chronic obstructive pulmonary disease.

Study Findings

The researchers determined that they were able to understand health patterns related to specific prescribed medications and determine which treatments were more effective by analyzing EHRs.

They added that the EHR analysis offers a larger and more diverse overview of the general population than current clinical trial methods.

The researchers also noted that using EHRs allows the analysis to be conducted with minimal effects on the lives of the patients, whose involvement in the process stops after their initial consent.

According to the researchers, 26 out of 27 general practitioners who participated in the study expressed strong support for the use of patients' EHRs for research purposes. In addition, 10 patients who were interviewed by the researchers all said that their involvement in trial was an acceptable practice

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EHRs Detect Depression When Many PCPs Can’t

EHRs Detect Depression When Many PCPs Can’t | healthcare technology |

Depression is one of the hardest disorders to diagnose, yet it affects 14 percent of the world’s population. Researchers have found factors in EHRs may be key to predicting a diagnosis of depression.

While depression comes at a high cost to those who suffer from it, the actual price tag in the United States reaches over $44 billion annually. This takes into account, among other things, lost productivity and direct expenses. Depression is a diagnosis that is often missed by primary care physicians, despite the fact that it is the second most common chronic disorder they treat.

According to EHR Intelligence, researchers from Stanford University have worked to use EHR systems as a tool to help predict depression diagnoses. In the study, published by the Journal of the American Medical Informatics Association, researchers say valuable information already stored in the EHR can be used to predict depression up to a year in advance.

“Depression is a prevalent disorder difficult to diagnose and treat. In particular, depressed patients exhibit largely unpredictable responses to treatment,” explain researchers. “Many depressed patients are not even diagnosed … primary care physicians, who deliver the majority of care for depression, only identify about 50 percent of true depression cases.”

The Stanford team used EHR data including demographic data, ICD-9, RxNorm, CPT codes, progress notes, and pathology, radiology, and transcription reports. From these, they used a model which factored in three criteria: the ICD-9 code, the presence of a depression disorder term in the clinical text, and the presence of an anti-depressive drug ingredient term in the clinical text.

These factors were then compared to predict a diagnosis of depression, response to treatment, and determine the severity of the condition.

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Incorporate patient-generated health data into the EMR

Incorporate patient-generated health data into the EMR | healthcare technology |

Though the industry has made outstanding progress in adopting EMRs, the practice of data acquisition from patients remains cloudy.

A recommendation from the HITSC Meaningful Use Workgroup would require practices with electronic health records (EHRs) to allow 10 percent of patients to report PGHD electronically.

If approved in meaningful use stage 3, the final stage of’s EHR incentive program, it could push hospitals to incorporate patient-generated data.

This requirement may seem like a relatively simple intervention, but the ramifications are quite significant. If clinical decision-making is made on the basis of data supplied by patients and documented in the EMR, how can clinicians be sure that such data is complete, correct and valid? And will clinicians like me learn to rely on it, or will we disregard it due to concerns about its validity or barriers to integrating it into care flow?

Furthermore, if a patient is in control of her health data entry, who is ultimately responsible for its completeness and accuracy — the patient or the clinician?

Incorporating biometric data into the EMR, an exciting prospect, is even more complex. Though clinicians are quite familiar with data entry from FDA-approved medical devices such as blood glucose meters, pacemakers and pulmonary function units, data from a myriad of consumer-driven health devices (Fitbit and others) will soon seek to flex their way into EMRs.

Patients clearly value these data; a recent Pew Research report noted that 60 percent of adults claim to track their exercise routine, weight or diet, meaning providers have some catch-up to do in order to meet patients halfway. Some health systems, such as Partners HealthCare, have already been experimenting with the incorporation of PGHD from remote devices into the EMR, and other institutions should follow.

Consumer health data devices are moving ahead at a staggering pace, and while the health care system can’t quite keep up, strategic planning should be happening now.

Despite the challenges, incorporating PGHD is a necessary evolutionary step for health care. Intelligently designed, well-executed systems that fully incorporate and display PGHD in a meaningful way will improve shared decision-making and enable patients as active care partners. Keen clinicians and patients will stay closely tuned to the numerous transformations to come.

Laurie Bolick Wolf's curator insight, June 17, 2015 2:31 PM

A review of the use of patient generated health data and its implications on healthcare in the future.  Having patient's enter their health history into the EMR prior to arrival is a time saving step that may allow the provider to spend more time with the patient for diagnosis and education.  However, this means that an accurate review of what the patient has entered must also be done.  If the provider is not entering the information his/herself, there is too much opportunity for something to be missed or entered incorrectly.  In regards to the potential for future collaboration between patient worn devices and EMR, I am not sure how helpful this is.  While it is nice for the provider to see that you have been getting exercise, it really does not make any change in the plan of care. 

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Safety Assurance Factors for EHR Resilience (SAFER Guides)

Safety Assurance Factors for EHR Resilience (SAFER Guides) | healthcare technology |

The safety and safe use of electronic health records (EHRs) is a priority for healthcare organizations.

The SAFER guides consist of nine guides organized into three broad groups. These guides enable healthcare organizations to address EHR safety in a variety of areas. Most organizations will want to start with the Foundational Guides, and proceed from there to address their areas of greatest interest or concern.

The guides identify recommended practices to optimize the safety and safe use of EHRs. The content of the guides can be explored here, at the links below, or interactive PDF versions of the guides can be downloaded and completed locally for self-assessment of an organization’s degree of conformance to the Recommended Practices. The downloaded guides can be filled out, saved, and transmitted between team members.

To download the guides as well as to viewa  video explaining how to use the SAFER Guides visit:

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What’s missing from the electronic health record

What’s missing from the electronic health record | healthcare technology |

Patient adherence and the EHR

This clinical vignette reflects the reality that only one-quarter to one-third of patients follow up as directed after ED visits.1 Thus, dependence on patient adherence to care recommendations will continue to result in missed opportunities for both health maintenance and disease prevention. The EHR, which might have provided a safety net in this instance, failed to do so because an otherwise conscientious physician did not document a suspected diagnosis. In this case, the EHR’s utility was significantly limited by incomplete data entry.

How might the EHR have altered the course of events that led to the adverse reproductive outcome in this patient? Had the suspected diagnosis of diabetes been recorded, subsequent caregivers would have had the opportunity to see it in the problem list and to have acted upon it. Incomplete ED documentation effectively thwarted one of the putative “virtues” of this technology, namely, linkage of health information directly to the patient rather than to the provider of care.

Data not entered in the electronic chart or hidden from view are equivalent to a paper record locked in a medical office filing cabinet or a hospital’s health records department. In either circumstance, important patient information is unavailable precisely because it is sequestered by the care provider.

Disease prevention and the EHR

In response to anecdotal evidence as well as evidence supporting the effectiveness of prenatal health promotion,2,3 we evaluated our own EHR for its potential to help our patients avoid adverse outcomes.
Recognizing the frequency of unplanned pregnancy and the fact that 30% of women who conceive have modifiable risk factors that could be treated to improve pregnancy outcome,3 we created a case-finding algorithm to screen all outpatient encounters from our health system’s unified EHR (EPIC, Verona, WI).

Patient data are routinely transferred each evening into an enterprise-wide data warehouse (EPIC Clarity with Oracle and IBM COGNOS) allowing for subsequent data mining for quality improvement, care innovation and research.

We sought to identify reproductive-age women of child-bearing potential and use their data entries to identify risk factors for adverse maternal or fetal outcome. Child-bearing potential was defined as women of reproductive age lacking a history of either sterilization or hysterectomy, and without documented contraceptive use, while the preconception risk factors chosen included morbid obesity, hypertension, poorly controlled diabetes, anemia, renal insufficiency, teratogen exposure, and alcohol, tobacco and illicit drug use.
The algorithm was designed to mitigate incomplete charting by cross-referencing multiple electronic data fields (problem lists, medical and surgical histories, clinical diagnoses, laboratory results, medication orders, and ICD-9 codes), so that multiple dimensions of the record for each risk factor were queried.4

Where the EHR falls short

Although our case-finding strategy showed promise, accurate identification of women of child-bearing potential was problematic because up to 25% of patients were incorrectly classified due to incomplete electronic records.4 Poor data quality has been noted by others to confound the EHR5,6 and administrative databases from insurance claims and birth certificates are also notorious for missing information.7

In the domain of funded clinical research, a standard for precise data entry has existed for decades. Agencies including the National Institutes of Health place great emphasis on complete data capture and auditing, often insisting on robust data monitoring committees for just this purpose.

One needs only to reflect on the new norm of electronic banking to realize how important data precision is to our wealth, but, apparently, not yet to our health.

We believe it is time to insist that electronic medical records are assiduously created and carefully maintained so that they are more than just expensive versions of their paper ancestors. We suggest that caregivers need to conceptualize data entered on behalf of patients as of the highest value to their current and future health status, making accurate completion of the EHR an act of professionalism.

It is not a coincidence that Stage I meaningful use criteria include proper utilization of the problem list as an essential element in electronic recordkeeping.8 Accurate and comprehensive charting is no different than other measures designed to improve patient health and safety. While the activity may not feel particularly important on its face, our clinical vignette should leave no doubt as to the potential consequences of getting this wrong.

- See more at:

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Lets Get Industrial Engineers to Design EHRs

Lets Get Industrial Engineers to Design EHRs | healthcare technology |

Many EMR designers are seduced by the idea that since users are already familiar with paper forms that the paper form metaphor is a good user interface. It is not.EMRs that try to mimic traditional paper medical records are not well designed for high-usability, high-productivity data and order entry.

An EMR designed and implemented using industrial engineering principles and techniques is a fundamentally different EMR that the traditional EMR. Instead of starting with a user interface that looks like a paper form, the user interface is essentially derived, using scientific and engineering principles, from the human body’s response to physical, physiological, and cognitive workload.

Perception, attention, cognition, motor control, memory storage and retrieval all interact with work environment and job demands to result in a body of knowledge about mental workload, vigilance, decision making, skilled performance, human error, human-computer interaction, and training. (This is not dissimilar to the way in which medical knowledge is derived using scientific methods from the structure and function of the human body.)

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The Road toward Fully Transparent Medical Records

The Road toward Fully Transparent Medical Records | healthcare technology |

As patients become familiar with medical records and clinical notes, they consider new opportunities and risks. Some say they have become more careful about what information they share with clinicians, and some ask for more control over access to their information.

Providers are experimenting with strategies that help patients protect their privacy with regard to mental health, sexual function, suspected abuse, or other sensitive topics. And though family caregivers may find that reading notes improves their understanding of care plans and reduces stress, it's a complex task to establish separate proxy access based on patients' preferences about who gets to see what.

As transparent practice evolves, it's impossible to predict how much patients may stray from long-standing conventions. Portals afford patients secure access to their information, and doctor–patient confidentiality remains undisturbed.

But patients' attitudes toward privacy may change as online access allows them to share documents, including notes. A third of patients in the OpenNotes study expressed concern about privacy, but more than one in five shared a note with others who could clarify meanings, offer clinical insights or second opinions, or — for those participating in the patient's care — improve their own knowledge. Indeed, some patients may choose to post their providers' progress notes on Facebook, Twitter, medical forums, and other social media, potentially exposing clinicians to public scrutiny and crowd-fueled praise or criticism.

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Few Doctors Use Personal Smartphones for EHR Access

Few Doctors Use Personal Smartphones for EHR Access | healthcare technology |

A new report finds that while nearly all physicians have a smartphone, few said they would use their personal phone to access electronic health records. Meanwhile, 70% of physicians said hospital IT organizations are not making adequate investments in physician mobile computing and communication.

The report found that doctors prefer to use consumer text messaging for clinical communication over secure messaging applications because it is simpler to do so.

Eighty-three percent of respondents expressed frustration over using an EHR system for clinical communication due to:

  • Inadequate messaging capabilities;
  • Limited usability; and
  • Poor interoperability

However, while 96% of physicians said they use smartphones, only 10% of those who do so said they would use them to access EHRs.

Meanwhile, 70% of respondents said they "believe that hospital IT organizations ... are making inadequate investments to address physician mobile computing and communication requirements at point of care."

more at

nrip's insight:

It would have been surprising if the report found it otherwise. The majority of todays EHR's are still clunky and have unfriendly workflows. Mobile users (including doctors obviously) will require interfaces which are clean and easy to navigate, and the mobile usage workflow must be extremely simple.

With a number of firms promoting their newer shiny EHRs with separate Mobile Specific versions , it will be interesting to see the results of such a study 24 -36 months down the line.

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Can EHRs power up the fight against epidemics?

Can EHRs power up the fight against epidemics? | healthcare technology |

Government health IT leaders say electronic health record systems can expand information sharing and help public health responders fight the spread Ebola and future viruses.

While the United States avoided a public health crisis from the Ebola virus, the possibility of an epidemic at home got government health IT leaders thinking about how electronic health records might be used to expand information sharing and help public health responders fight the spread of Ebola and future viruses.

There are significant hurdles to clear before the EHRs used in clinical care will be able to really help state, local and federal health officials track and respond to fast-moving outbreaks in real time, according to those at recent Health IT Policy Committee meeting on the potential for using EHRs to fight epidemics.

The problem of interoperability and data transfer between EHR systems, medical laboratories and public health databases is one big issue. More broadly, there is a lack of what experts call "bidirectionality" between health records, preventing health officials – either for technical or privacy reasons – from accessing individual patient records.

Ultimately, broader use of EHRs to detect and respond to epidemics will require changes in technology. The passive surveillance of patient EHRs using analytic tools could give greater velocity to detecting not just viral disease outbreaks, but environmental risks, contaminated food and medicine as well as other large-scale health problems that are clustered geographically or in certain demographic groups.

That’s not to say epidemiology is lacking in high-tech approaches. New York City, for example, was able to use cell phone location information and subway fare card data to conduct contact tracing on individuals that may have come into contact with the Ebola virus while traveling. However, aggregating that information, and making it available at scale through an EHR platform, appears to be a long way off.

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Can doctors actually keep up with the wearables market to make it worth your while?

Can doctors actually keep up with the wearables market to make it worth your while? | healthcare technology |
With the wearables and health apps markets booming, where do doctors stand in terms of actually making use of the information?

So you are being proactive about your health by purchasing wearable devices and apps, but how helpful is it really if your doctor isn’t up to speed with the technology or able to interpret the data?

Dr. Paul Abramson, a primary care doctor in San Francisco told NPR that as much as these new devices are promoting good health generally, it’s not necessarily practical for doctors to interpret all of the data.

“Going through it and trying to analyze and extract meaning from it was not really feasible,” he says. “I get information from watching people’s body language, tics and tone of voice. Subtleties you just can’t get from a Fitbit or some kind of health app.”

Part of the issue is that FitBits and Apple Watches aren’t regulated by the FDA – they are considered “low-risk devices” and don’t require approval because they aren’t used for diagnosis or treatment. For that reason, it’s challenging for doctors to treat the data like valid information.

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4 ways EHR vendors are building better systems

4 ways EHR vendors are building better systems | healthcare technology |

Physicians continue to express dissatisfaction with the usability and the workflow features of electronic health records (EHRs), yet these information systems don’t seem to improve.

One reason, experts say, is that vendors have poured most of their research and development budgets into meeting the requirements for meaningful use (MU) and the International Classification of Diseases-10th revision (ICD-10).

Despite all of this, however, some innovations are starting to enhance the usability of EHRs.

These include

  • refinements in natural language processing,
  • advances in EHRs designed for mobile devices,
  • the addition of context to clinical decision support (CDS),
  • and the spread of direct clinical messaging.

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Will EHR data stand up in court?

Will EHR data stand up in court? | healthcare technology |

While healthcare stakeholders naturally focus on the medical reliability of data recorded in EHRs, there's another question worth asking: Would the information EHRs contain stand up in a court of law? 

According to a new analysis published in the Ave Maria Law Review, the answer is a pretty clear "No."

There has been no shortage of debate among healthcare stakeholders concerning whether EHRs are reliable and, if not, how to make them so. But the three authors of the Ave Maria piece take, not surprisingly, a lawyer's view on the question of reliability. And almost from the beginning they point to some significant problems.

For example, they cited the fact that the data in EHRs are used, naturally, to determine payments to providers. Consequently, "there is a substantial financial incentive to attuning (sic) the record systems' functional priorities to assure that the resulting record artifact leverages the maximum payment, dissociated from its accuracy and reliability as a business record of patient care events."

Currently,  healthcare doesn't have a similarly stringent approach to its own record — but if it did, it seems clear that both doctors and patients would benefit.

Link to the rest of this article:

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EHR + Geography = Population Health Management

EHR + Geography  = Population Health Management | healthcare technology |

Duke University Medicine is using geographical information to turn electronic health records (EHRs) into population health predictors. By integrating its EHR data with its geographic information system, Duke can enable clinicians to predict patients' diagnoses.

According to Health Data Management, Sohayla Pruitt was hired by Duke to run this project; “I thought, wow, if we could automate some of this, pre select some of the data, preprocess a lot and then sort of wait for an event to happen, we could pass it through our models, let them plow through thousands of geospatial variables and [let the system] tell us the actual statistical significance,” Pruitt says. “Then, once you know how geography is influencing events and what they have in common, you can project that to other places where you should be paying attention because they have similar probability.”

iHealth Beat explains that the system works by using an automated geocoding system to verify addresses with a U.S. Postal Service database. These addresses are then passed through a commercial mapping database to geocode them. Finally, the system imports all U.S. Census Bureau data with a block group ID. This results in an assessment of socioeconomic indicators for each group of patients.

“When we visually map a population and a health issue, we want to give an understanding about why something is happening in a neighborhood,” says Pruitt. “Are there certain socioeconomic factors that are contributing? Do they not have access to certain things? Do they have too much access to certain things like fast food restaurants?”

Duke is working to develop a proof of concept and algorithms that would map locations and patients. They are also working on a system to track food-borne illnesses.

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Electronic health records ripe for theft

Electronic health records ripe for theft | healthcare technology |

America’s medical records systems are flirting with disaster, say the experts who monitor crime in cyberspace. A hack that exposes the medical and financial records of hundreds of thousands of patients is coming, they say — it’s only a matter of when.

As health data become increasingly digital and the use of electronic health records booms, thieves see patient records in a vulnerable health care system as attractive bait, according to experts interviewed by POLITICO. On the black market, a full identity profile contained in a single record can bring as much as $500.

“What I think it’s going to lead to, if it hasn’t already, is an arms race between the criminal element and the people trying to protect health data,” said Robert Wah, president of the American Medical Association and chief medical officer at the health technology firm CSC. “I think the health data stewards are probably a little behind in the race. The criminal elements are incredibly sophisticated.”

The infamous Target breach occurred last year when hackers stole login information through the retailer’s heating and air system. Although experts aren’t sure what a major health care hack would look like, previous data breaches have resulted in identity and financial theft, and health care fraud.

Significant breaches are already occurring. Over the course of three days, hackers using a Chinese IP address infiltrated the St. Joseph Health System in Bryan, Texas, and exposed the information of 405,000 individuals, gaining names, address, Social Security numbers, dates of birth and other information.

It was the third-largest health data breach tracked by the federal government.

The L.A. Gay & Lesbian Center reported late last year that hackers attacked its computer systems over a course of two months trying to steal credit card, Social Security and other financial information. About 59,000 clients and former clients were left vulnerable.

While a stolen credit card or Social Security number fetches $1 or less on the black market, a person’s medical information can yield hundreds of times more, according to the World Privacy Forum. Thieves want to hack the data to gain access to health insurance, prescription drugs or just a person’s financial information

The Identify Theft Resource Center — which has identified 353 breaches in 2014 across industries it tracks, says almost half occurred in the health sector. Criminal attacks on health data have doubled since 2000, according to the Ponemon Institute, an industry leader in data security.

Health care is the industry sector least prepared for a cyberattack, according to security ratings firm BitSight Technologies. The industry had the highest volume of threats and the slowest response time, leading the FBI in April to issue a warning to health care providers.

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Pilot programs give school nurses access to EHRs to help kids manage chronic diseases

Pilot programs give school nurses access to EHRs to help kids manage chronic diseases | healthcare technology |

Coordinated care for chronic diseases in kids is now part of the school nurse's terrain. In some states, nurses are getting access to EHR data.

Although the school nurse is a familiar figure, school-based health care is unfamiliar territory to many medical professionals, operating in a largely separate health care universe from other community-based medical services.

Now, as both schools and health care systems seek to ensure that children coping with chronic conditions such as diabetes and asthma get the comprehensive, coordinated care the students need, the schools and health systems are forming partnerships to better integrate their services. In these projects, some funded by the health law, school health professionals gain access to students' electronic health records and/or specialists and other health system resources. Such initiatives currently exist or are on the drawing board in Delaware, Miami and Beaverton, Ore., among other locations.  

School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student’s seizure or asthma attack, among many other things.

A 2007 study found that 45 percent of public schools have a full-time nurse on site, while 30 percent have one who works part time. In addition to school nurses, 12.5 percent of school districts have at least one school-based health center that offers both health services and mental health or social services, according to the federal Centers for Disease Control and Prevention’s 2012 Schools Health Policies and Practices Study. School nurses often work closely with school-based health centers, referring students there as needed.

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Trends and Drivers of Primary Care Physicians' Use of #HealthIT

Trends and Drivers of Primary Care Physicians' Use of #HealthIT | healthcare technology |

Commonwealth Fund researchers analyzed data from surveys of primary care physicians conducted in 2009 and 2012 to check on the progress of health IT adoption.

Adoption of health information technology (HIT) by physician practices rose considerably from 2009 to 2012, yet solo physicians lag practices of 20 or more and certain functions—like electronically exchanging information with other physicians—have been adopted by only a minority of providers. Physicians who are part of an integrated delivery system, share resources with other practices, and are eligible for financial incentives, have higher rates of HIT adoption.

Doctors are using HIT in greater numbers, spurred on in part by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which provided billions to help build a national HIT infrastructure. Commonwealth Fund researchers analyzed data from surveys of primary care physicians conducted in 2009 and 2012 to check on the progress of HIT adoption and to see how certain factors—like being part of an integrated health system or using shared technical assistance programs—can influence technology take-up.

Key Findings
  • From 2009 to 2012, the rate of adoption of electronic medical records (EMRs) by U.S. primary care physicians increased by half, from 46 percent to 69 percent. HIT use rose particularly in order entry management: the proportion of physicians able to send prescriptions electronically to pharmacies nearly doubled, from 34 percent to 66 percent; electronic prescribing increased from 40 percent to 64 percent; and electronic ordering of lab tests grew from 38 percent to 54 percent.
  • In 2012, 33 percent of primary care physicians could exchange clinical summaries with other doctors, and 35 percent could share lab or diagnostic tests with doctors outside their practice.
  • As of 2012, a minority of physicians provided electronic access for patients. Roughly one-third or fewer allowed patients to electronically view test results, make appointments, or request prescription refills.
  • Practice size is a major determinant of HIT adoption. Half of physicians in solo practices use EMRs, compared with 90 percent of those in practices of 20 or more physicians.
  • Physicians who are part of an integrated delivery system (like Kaiser Permanente or the Veterans Administration), those who have arrangements with other practices to share resources (technical assistance programs for clinical information systems or quality improvement), and those who are eligible for financial incentives, have higher rates of HIT adoption.

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How does patient engagement transform into useful EHR data?

How does patient engagement transform into useful EHR data? | healthcare technology |

Patient engagement represents the next aim of healthcare reform through the adoption of health IT systems and services. It just received a boost from PCORI which awarded $93.5 million for the creation of 29 clinical research data networks that will combine to form its National Patient-Centered Clinical Research Network (PCORnet).

A major aim of establishing these networks is to enable the patient population to play an active role in how their care is delivered. “One of the reasons people think we should be engaging patients more actively is to make sure that as we do research we’re measuring and assessing the kinds of things they want to know when they’re making medical decisions,” says Elizabeth McGlynn, PhD, Director of the Center for Effectiveness & Safety Research at Kaiser Permanente.

“While we appreciate that more traditional biometric information may be important,” she continues, “there are a number of other things that any of us who have had to make decisions about whether or not to have a surgical procedure or take a particular drug would like to know beyond some of that information.”
McGlynn and her team of researchers will rely on its network, Partners Patient Outcomes Research To Advance Learning (PORTAL), to change how a healthcare organization learns from its patients, namely in bridging the gap between the latter and researchers. “The whole area of engaging patients more actively and comprehensively in research is an evolving one. 

At a high level, the challenges for the project are two-fold. On the one hand, researchers need to be able to understand how patients want to be engaged:

We know that patients aren’t homogenous; we know that there’s a range of opinion. These kinds of tools give us the chance to continue to appreciate the diversity of ideas and opinions and avoid trying to just get to the one or the two leading ideas but really to think. As people are exploring the notion of what personalized medicine means, how do we make sure that we’re eliciting information from people about what’s important to them personally?

On the other hand, they must tackle the challenge of making this feedback available to clinicians in a meaningful way:

One of our big challenges is finding ways to effectively integrate that information into the electronic health record. We have some work underway right now that’s given us some early insights into what patients are willing to provide if their doctors are going to see it and use it but if it’s just a hypothetical exercise, not so interested.

Mike Vassel's curator insight, January 15, 2014 1:54 PM

Interesting article.  I believe that a healthy patient is engaged and proactive in their own wellbeing. 

Renzogracie academy's curator insight, January 17, 2014 6:03 AM
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Drug Companies Could Use EHR Systems for Targeted Marketing

Drug Companies Could Use EHR Systems for Targeted Marketing | healthcare technology |

Pharmaceutical companies increasingly are using electronic health records to analyze patient data and market their products to consumers and physicians through advertisements and email campaigns.

Electronic health record systems could be used by pharmaceutical companies to market their products to physicians and consumers,Reuters reports.

Pharmaceutical companies historically have gathered patients' de-identified data from insurers, pharmacies and public records to improve their marketing strategies.

However, drug companies can collect and analyze data through EHR systems and use that information to reach out to consumers and doctors.

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