The Department of Veteran Affairs (VA) is partnering with the National Cancer Institute (NCI) and the Department of Defense (DoD) to form the nation’s first screening program intended to provide targeted and individualized therapies for cancer patients.
The tri-agency precision medicine partnership is called the Applied Proteogenomics Organizational Learning and Outcomes (APOLLO) and is part of the NCI’s Cancer Moonshot initiative. Proteogenomics is a combination of genomics, the study of the human genome, and proteomics, the study of a specific proteome (set of proteins).
Researchers in the APOLLO program will regularly screen tumors for protein and gene information in order to provide targeted and customized therapies for lung cancer patients in VA and DoD medical programs. Approximately 8,000 veterans in the VA system are diagnosed with lung cancer every year. The program will eventually include other types of cancer.
APOLLO clinicians and researchers will classify tumors in veterans’ lungs based on gene changes in the tumors, as well as the levels of proteins. The researchers will then use the findings to either recommend targeted therapies or refer patients to the appropriate clinical trials. The goal of the program is to share the information gathered with the global cancer community in order to provide precision medicine therapies to cancer patients.
“APOLLO will create a pipeline to move genetic discoveries from the lab to VA clinics where Veterans receive cutting-edge cancer care,” VA Secretary Robert A. McDonald said in a press release. “This is an example of how we are striving to be an exemplary learning health care system. We are proud to join our federal partners in this exciting initiative, and we expect it will lead to real improvements in the lives of those affected by cancer.”
The NCI hopes to use precision medicine to accelerate research that will help identify which treatments work best for which cancer patients. APOLLO will complement other Cancer Moonshot initiatives, including a partnership between the VA and IBM that uses the Watson supercomputer to interpret tumor sequencing results.
Vice President Joe Biden, whose son Beau passed away in 2015 after a battle with brain cancer, leads the Cancer Moonshot Initiative.
If you’re a patient of a hospital or physician that is using the technology of a CommonWell Health Alliance member—including Cerner Corp., athenahealth, Inc., and McKesson Corporation, to name a few—then you’ll be able to get your health data via the CommonWell network.
CommonWell is now allowing people to self-enroll in the interoperability organization and be able to view their health data on the network. MediPortal, a company that focuses on data exchange and patient engagement, and Integrated Data Services, Inc., a provider of technologies that allow patients to retrieve and control their medical data, both CommonWell members, say they will offer these new services through their patient portals by the end of the year.
Enabling patients to enroll and link their health records to the network means patients will be able to give their providers quick access to important health data and improve care coordination, according to the release.
“Far too often individuals and the people who care for them are stymied by the onerous task of accessing their health data,” Jitin Asnaani, executive director of CommonWell Health Alliance, said in the release. “By enabling these services, our CommonWell members will empower people to be more engaged in managing their health and the health of their loved ones.”
Although the importance of patient involvement in health data has been highlighted by the White House and the Office for Civil Rights at the Department of Health and Human Services, a survey from HealthMine found that 53% of patients surveyed can’t access their health data online. Furthermore, 74% of healthcare consumers surveyed said that easy electronic access to health data would improve both their knowledge of their health and communication with their doctors.
Among the CommonWell members participating in the initiative are Aprima Medical Software, Inc., athenahealth, Cerner, Evident, Modernizing Medicine, Inc., and RelayHealth, a subsidiary of McKesson that McKesson is selling to health IT vendor Change Healthcare.
However, the Department of Health and Human Services released healthcare app development guidelines to help app developers understand if their app deals with protected health information and if the app needs to be HIPAA compliant. One scenario under which a mobile health app would be covered by HIPAA is if the app is developed on behalf of a covered entity.
ECPS is now allowed in all 50 states, and the number of EPCS transactions rose from 1.67 million 12.8 million last year, a 600% increase, according to a Surescripts release accompanying the company’s 2015 National Progress Report.
Meanwhile, the number of EPCS-anabled prescrbers rose 359%, from 15,195 at the end of 2014 to 69,800 at the end of 2015, according to Surescripts.
However, EPCS-enabled pharmacies and physicians are not uniformly distributed across the country.
EPCS is well established in Northeast states such as New York — which ranked number 1 with 91% of pharmacies enabled — and Massachusetts, as well as in California and Texas, for example.
Lagging, however, are southeast states such as Georgia and Florida, which ranked 44th in the Surescripts survey with 73% of pharmacies enabled. Also low in the rankings are Montana and North Dakota.
As of December 2015, opiods accounted for 32% of all EPCS prescriptions. Opioid abuse was involved in some 28,647 deaths in 2014 and opioid overdoses quadrupled from 2010 to 2014, according to sources cited by Surescripts.
So while EPCS has become common, most prescribers of controlled substances, including not only opioids but also other potentially addictive controlled drugs such as Xanax and Adderall, are still using paper prescriptions.
EPCS is a safer and more controllable way of prescribing controlled drugs because it sharply cuts down on fraud and improper prescribing, according to Surescripts.
It may be time for dentists to sink their teeth into meaningful use.
Dentists, while theoretically eligible for the federal EHR incentive program, have for the most part stayed away because there were no penalties for not participating and many low-cost dental EHR programs are available that do not qualify as federally certified health IT.
That could be changing now.
The American Dental Association officially says that for most dentists there is no deadline to take part in meaningful use. However, this year Medicare and Medicaid-eligible dentists who have not adopted EHRs and attested to meaningful use will receive for the first time a 1% Medicare or Medicaid payment reduction, according to a post on the Dentistry IQ website by a healthcare compliance consultant.
That penalty will increase each year that eligible dentists (those whose Medicare or Medicaid patients make up at least a third of their practices) do not attest to meaningful use, up to a maximum of 5%, according to the site.
Dentists are eligible for up to $63,750 per practitioner for adopting EHRs and demonstrating meaningful use, but only a small fraction of dentists have opted in, according to RangerNetworks, a Texas dental EHR vendor.
By comparison, 96% of hospitals and 56% of office-based physicians have demonstrated meaningful use of EHRs, according to ONC.
Meanwhile, costs for dental EHRs range from $15,000 to $70,000, plus time and effort to install the systems and attest to meaningful use.
Still, Christine Queally Foisey, the Dentistry IQ article author and president and CEO of consulting firm MedSafe, lists these benefits for dentists who digitize their practices:
- Improved quality and patient safety
- Reduced paperwork and storage issues
- Increased efficiency and productivity
- E-prescribing capability
- More efficient billing and improved reimbursement
- Increased accuracy
Application program interfaces (APIs)– routines, protocols, and tools used when building software—are important not only for interoperability but also to the future of healthcare, according to the Office of the National Coordinator for Health Information Technology (ONC).
“APIs have been and will continue to be a key element toward enabling interoperability among consumers and health care providers,” Peter Ashkenaz, a spokesperson for ONC, said in a MeriTalk article. “Publicly available APIs in health care and technology solutions built using them could help usher in a new wave of advanced tools that can more seamlessly connect consumers and health care providers to data.”
And then there’s the new healthcare law, the Medicare Access and CHIP Reauthorization Act (MACRA). It says providers will be rewarded for using technology to improve care outcomes and will be able to customize health IT, and interoperability will be a top priority.
Open-source APIs could also make interoperability more achievable because they allow the exchange of secure health data through the cloud, the article said.
However, there are still barriers to APIs really taking hold in health IT.
“Continued work remains to align the use of different data formats, codes, and semantic terminology in order to enable the seamless use of data,” Ashkenaz said in the article.
He added that a few steps need to be taken before APIs can live up to their full potential in health IT:
- Developers should establish one standardized set of publicly accessible API specifications that have been tested and deployed by developers and then put to use by healthcare providers
- Other software developers need to be able to use those APIs unimpeded to create innovative solutions
- Consumers and providers must be able to obtain new tools and applications that deliver better experience and constantly update to better versions
Despite the challenges, the outlook for APIs ultimately looks good because they will play an important role when it comes to the changes in reimbursement models, such as those embodied in MACRA, Ashkenaz said.
“The use of APIs–and the tools built off them–will likely be a key aspect of any health IT developer and provider strategy to participate in future payment programs, including alternative payment models,” Ashkenaz said. “As demand for health information exchange continues, so too will the demand for more efficient ways to exchange, aggregate, and analyze data.”
There’s no denying that mHealth apps have the potential to help patients better manage their health. But according to a recent study conducted by researchers from the University of California, San Francisco, mHealth apps are too complicated for the populations who would benefit the most from their use. The study surveyed 26 patients at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, a UCSF partner hospital that treats many low-income patients.
MHealth apps can provide patients with educational information about their conditions and allow them to track health data over time. But the current design of 11 commercially available mHealth apps for depression and diabetes observed by UCSF researchers are not user friendly, often requiring significant manual data entry. The apps also lacked large buttons and easy to follow navigation, which frustrated many of the survey participants.
The complexity of mHealth apps can lead to health disparities in vulnerable populations such as those with low health literacy, which refers to an individual’s ability to obtain, process and understand basic health information and services. Of the patients surveyed, 70% were found to have low health literacy. In a February 2016 interview with SearchHealthIT news writer Kristen Lee, Ahmed Albaiti, founder and CEO of digital health consultancy Medullan, Inc., said people with lower health literacy often have chronic conditions and are in an age group that makes it difficult to learn new technology.
While patients with diabetes and other chronic conditions could benefit from using tools such as mHealth apps and wearable devices, they either can’t afford them or do not see the value in using such tools, Lisa Gualtieri, assistant professor of public health and community medicine at Tufts University and founder of RecycleHealth, told SearchHealthIT. There is also a lack of awareness, as wearable device companies would target the people who want, rather than need, their products. However, the potential for increased mHealth app usage is there – a 2015 report by the Pew Research Center found that 64% of American adults own a smartphone. Furthermore, 62% of smartphone owners used their phones to look up information about a health condition.
When the government gets involved with a certain technology in healthcare you know there’s a good chance that technology has some promise. Just look at what happened with EHRs and the government’s meaningful use program.
Well, now the government is starting to get involved with blockchain technology. HHS and ONC announced the “Blockchain and Its Emerging Role in Healthcare and Health-related Research” Ideation Challenge.
HHS and ONC describe blockchain technology as “a data structure that can be timed-stamped and signed using a private key to prevent tampering.”
The agencies categorize the main types of blockchain as public, private and consortium.
Other industries are already getting in on the technology. Companies such as Microsoft have already formed partnerships to develop blockchain technology and experts say blockchain may disrupt the financial and legal fields as well.
HHS and ONC maintain blockchain could also have several uses in healthcare, including:
- Computable enforcement of policies and contracts
- Management of internet of things devices
- Distributed encrypted storage
- Distributed trust
However, blockchain technology and its applicability to healthcare is still evolving and maturing, HHS and ONC said in their announcement.
The agencies said that those who support the use of blockchain in healthcare think it could be used to address concerns regarding the privacy, security and scalability of health records. Critics, on the other hand, say that this would take enormous processing power and specialized equipment, which would outweigh the benefits of the technology in healthcare.
The Ideation Challenge calls for white papers on the topic of blockchain and its potential uses in health IT.
HHS and ONC appear most interested in the cryptography aspect of the technology and the underlying fundamentals of blockchain. They also want to know how this technology could advance industry interoperability needs, help with patient centered outcomes, precision medicine and other needs within healthcare.
The agencies have solicited recommendations for the implementation of blockchain technology.
The winners of this challenge will get the opportunity to present their white paper at an industry-wide “Blockchain and Healthcare Workshop” co-hosted by ONC and The National Institute of Standards and Technology.
Female health IT professionals in the U.S. are paid less than their male counterparts, and the wage gap between the two has only grown larger over the past decade.
In 2006, the average female health IT worker was paid 80.7% of what her male counterpart earned, according to the biennial HIMSS Longitudinal Gender Compensation Disparity Study. In 2015, that number decreased to 78% of what male health IT workers earned.
The disparity in pay by tenure — defined by the study as how long a worker has been in their current position — has also widened since 2006. New female health IT workers who had less than one year tenure earned 83.2% of what new male health IT workers earned. Furthermore, female health IT workers with 15 or more years tenure were paid 77.7% of what their male counterparts earned. Then, in 2015, the wage gap between new male and female health IT workers widened while the gap between longer tenured male and female workers narrowed. New female health IT workers earned 72.1% of what male health IT workers earned, while those with 15 plus years tenure earned 85.9% of what their male counterparts with similar tenure earned.
There was also a discrepancy in pay between male and female workers with the same title, although the gap has narrowed for management level workers:
- Female health IT managers earned 91.7% of what male health IT managers were paid in 2006, but in 2015, female health IT managers earned 92.4% of what their counterparts earned.
- Female non-management level workers earned 93.7% of what their male counterparts earned in 2006 versus 91.7% in 2015.
- Female senior/executive managers earned 89.4% of what their male counterparts earned in 2006 versus 85.5% in 2015.
Among female health IT professionals who work for health IT vendors, the pay gap has narrowed since 2006. That year, female health IT workers earned 87.9% of what their male counterparts earned, compared to 91.0% in 2015. The gap has remained steady at 77.5% for female health IT professionals who work for hospitals, but has widened for other organization types: 77.4% versus 73.1% for female health IT professionals who work for other providers , such as nursing homes, and 80.6% versus 78.7% for those who work in other healthcare organizations, such as health information exchanges.
As far as actual salaries, a 2015 HIMSS Salary Survey found that female health IT workers earned $100,762 annually, while male health IT workers earned $126,262 — a 21% discrepancy that reflects that national gender wage gap between full-time female and male workers.
While about a third of U.S. hospitals reported to the Office of the Inspector General of the Department of Health and Human Services that they don’t have HIPAA-compliant EHR disaster recovery plans, most hospitals told OIG they have comprehensive plans to recover patient data after a disaster.
The OIG hospital disaster recovery survey, results of which were released July 22, came after widespread disruptions to hospital patient records after Hurricane Sandy hit the East Coast in 2012 and rapidly escalating cybersecurity threats to health data.
According to a release, OIG sent questionnaires to a sample group of 400 hospitals that receive meaningful use Medicare incentive funds asking about their EHR contingency plans, including:
- How they comply with HIPAA rules requiring all HIPAA-covered entities to have a contingency plan for disruptions to EHR systems, including maintaining a data backup plan, disaster recovery plan, emergency mode operations plan and having testing and revision procedures
- How they follow practices for emergency contingency planning recommended by the Office of the National Coordinator for Health IT (ONC) and the National Institute for Science and Technology (NIST)
- Their experience with EHR disruptions.
OIG staff also made site visits to six hospitals, where they reviewed EHR contingency plans and related documents.
Nearly all the hospitals reported having written EHR contingency plans and about two-thirds said they met the four HIPAA requirements OIG reviewed.
Most of the hospitals also said they followed ONC and NIST recommendations such as maintaining off site backed up EHR data, supplying paper backups when electronic records are unavailable and training staff on contingency plans.
More than half of the respondents said they had experienced an EHR disruption, and a quarter of those said they had delays in patient care as a result.
OIG also found that HHS’s Office for Civil Rights (OCR), which enforces HIPAA, does not specifically focus on EHRs when assessing HIPAA compliance for disaster recovery.
“Persistent and evolving threats to electronic health information reinforce the need for EHR contingency plans,” OIG concluded in the release. “This review and the cyberattacks that have occurred since 2014 underscore our previous recommendations that OCR fully implement a permanent audit program for compliance with HIPAA.”
OCR is now engaged in a second round of audits of selected healthcare organizations and their business associates.
Many observers expect these audits to be followed by a permanent audit program funded by revenues of fines levied on healthcare organizations found to have violated HIPAA.