President Trump and Veterans Affairs (VA) Secretary, David Shulkin, M.D., announced telehealth initiatives that will help give access to healthcare for veterans across the country.
“This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health… and also in suicide prevention,” Trump said in the release. “It will make a tremendous difference for the veterans in rural locations.”
Shulkin added that the “VA already has the largest telehealth program in the country. Last year, we had 700,000 veterans who got telehealth services through the VA.”
President Trump and Shulkin said the VA will be focusing on three specific telehealth initiatives:
- After working with the White House Office of American Innovation and the Department of Justice, Shulkin said he will be issuing a regulation that will authorize VA providers that use telehealth technologies to serve veterans no matter there that provider or the veteran patient is located in the country, a press release from the White House said. The initiative is called the “Anywhere to Anywhere VA Health Care”. Trump and Shulkin are hoping this initiative will empower the VA to hire providers in metropolitan areas with an abundance of clinical services and connect them to veteran patients in rural areas.
- The VA is also initiating a nationwide rollout of a new application called VA Video Connect which will provide secure and web-enabled video service that will make it easier to connect with providers via their mobile phones or personal computers. It is currently being used by more than 300 VA providers. It will be rolled out to VA providers and veterans across the country next year, the release said.
- There will also be a nationwide roll-out of an application to make it easier to schedule and change appointments called the Veteran Appointment Request (VAR) app, the release said. The app is currently available at several locations nationwide.
“What we’re really doing is, we’re removing regulations that have prevented us from doing this,” Shulkin said. “We’re removing geography as a barrier so that we can speed up access to veterans and really honor our commitment to them.”
The National Institutes of Health has chosen four community partners to join its All of Us precision medicine research program, which seeks to gather data from at least one million people in the United States to improve health. The program is part of the Precision Medicine Initiative created by President Barack Obama in 2015 and was formerly known as the PMI Cohort.
The partners will receive a combined $1.7 million to raise awareness about the research program among African Americans, Hispanics and Latinos, seniors and the LGBTQ communities. Researchers will use the data collected from the program to learn how individual biological, environmental and lifestyle differences influence disease and health.
Participants will be asked basic information about their health, family, home life and work. Researchers may request access to a participant’s electronic health record, and may ask participants to attend a local clinic where health information such as weight, height, blood pressure and heart rate will be collected.
Dara Richardson-Heron, chief engagement officer for All of Us, said in a release, “Medical breakthroughs have traditionally been based on findings from a limited portion of the U.S. population,” but that the hope is for “future research to include all of us.” Including diverse populations in precision medicine research enables healthcare to be tailored to individual differences, she added.
To that end, the initial group of awardees is:
- FiftyForward, which will share information about the program with economically disadvantaged older populations through lifelong learning centers and home-based centers.
- The National Alliance for Hispanic Health, which will launch bilingual local and national initiatives to promote the precision medicine research program in Hispanic communities.
- The Delta Research and Educational Foundation, in collaboration with Delta Sigma Theta Sorority and the National Council of Negro Women, which will launch a “Research Matters” health initiative to raise awareness for the program.
- The San Francisco General Hospital Foundation, which will engage gender and sexual minorities in the U.S.
Unlike many other precision medicine research programs, All of Us will not focus on one specific disease. Instead, it will act as a resource for researchers and explore ways to increase an individual’s odds of remaining healthy.
All of Us is currently in its beta testing phase and is slowly enrolling participants at different sites with the goal of expanding to at least 100 sites across the country.
“[The] American healthcare system is broken,” Robert Pearl, M.D., executive director and CEO of The Permanente Medical Group, said at the mHealth + Telehealth World Congress conference in Boston, and that includes healthcare technology systems too, he said.
In order to not be totally pessimistic, Pearl, also the president and CEO of the Mid-Atlantic Permanente Medical Group, did also talk about what certain healthcare technologies are getting right. But the overall message was that some serious work needs to be done.
Mainly, Pearl said that the approach to designing healthcare technology systems need to change. Right now, people are just building technologies and having the patient or physician adapt to the technology. Instead, Pearl said healthcare technology systems need to be designed for the specific problem it’s trying to solve. Therefore, the problem – whether it’s chronic disease or physician workflow – needs to be understood and the technology built around it.
“[EHRs do] not improve the quality of healthcare,” he said. What’s needed is a comprehensive EHR where all the information about the patient — and Pearl means all — is presented to the doctor. This means gathering information from different sources and presenting it to the patient’s physician and this requires interoperability.
Until a comprehensive EHR is created, other technologies important in healthcare will not be fully realized. One example is data analytics, Pearl said. “Data analytics is powerful,” he said, and it requires a comprehensive EHR in order to be truly effective.
What Pearl does see becoming a success is the use of video. He predicts that 30% of what doctors do in the near future will be done via video. Why isn’t video being widely used throughout healthcare today? Because it isn’t covered by insurance and therefore is not reimbursed, Pearl said.
One technology that Pearl is uncertain about in healthcare is artificial intelligence (AI). To Pearl, there are two possible use cases for AI. One is visual recognition meaning the technology would look for patterns that would ultimately lead to a diagnosis. And the second is determining the outcomes of treatment.
However, if you ask Pearl what he thinks of some of the AI technologies already out there, like IBM’s Watson and Apple’s Siri, he’ll tell you, “I believe Siri is going to be better than Watson.”
Why? Because you have Siri – and your mobile device — with you all the time.
With the efforts to repeal and replace the Affordable Care Act, many are questioning how changes in Washington, D.C., may affect the shift to value-based care.
A study commissioned by Quest Diagnostics, a company that provides clinical laboratory services, and Inovalon, a healthcare cloud vendor, surveyed physicians and health plan executives to gauge the nation’s journey to value-based care.
Here are the study’s key findings:
More tools are needed for shift to value-based care
While 53% of the health plan executive respondents said that physicians have the necessary tools to succeed in a value-based care healthcare system, only 43% of physicians said they have the necessary tools. However, this is an improvement from 2016, the study found. Last year, 44% of health plan executives said physicians had the necessary tools while only 29% of physicians said they had the necessary tools. The study points out that the gap between these perceptions decreased from 15% in 2016 to 10% in 2017, suggesting there has been progress towards alignment between health plans and physicians.
EHRs aren’t closing the gaps
Physicians and health plan executives also had differing views on the value EHRs bring to value-based care. The study found that 75% of health plan executives said EHRs have everything physicians need while only 54% of physicians thought so.
Furthermore, 70% of physician respondents said they do not see a clear link between EHRs and improved patient outcomes and 65% of physician respondents said that if they could get one key insight at the point of care via their EHR it would be information related to performance or quality measures that apply to individual patients.
Despite doubts about the value of EHRs, physicians are still investing in them and are open to their potential, the study said.
Physician respondents also said that they’d be willing to spend more time using technology if their EHRs could yield insights unique to their patients (71%). Furthermore, nine out of 10 physicians also agreed that access to quality and performance measures specific to patients is key to the shift to value-based care.
The study also found that co-investment in health IT between physicians and health plans may be the answer, with 85% of health plan executives saying co-investment in health IT would accelerate value-based care adoption.
“This finding supports other research that shows health plans experience greater benefits from the implementation of information technologies, such as EHRs, than the providers that implement them,” the study said. “Perhaps health plan executives are mindful of the significant investment required of physician practices to implement HIT solutions and the potential for co-investment to help surmount this challenge.”
In the wake of the recent WannaCry and Petya attacks that have hit healthcare organizations worldwide, a group of Boston researchers is urging the industry to consider the public health implications of cybercrime.
The researchers — two physicians and an information security professional — outlined their concerns in a perspective piece published in the New England Journal of Medicine. The group cites a Ponemon Institute survey in which nearly 90% of participating healthcare organizations said they have suffered a data breach in the past two years as proof that cyberattacks in the healthcare industry are a growing and prominent threat.
Potential threats to healthcare information security
Some of the threats to the industry include denial of service attacks and ransomware, such as the WannaCry and Petya attacks. Both forms of attacks had public health implications as they could impair a healthcare organization’s ability to deliver efficient care, the group said, but they stopped short of exposing patient data.
If patient data is exposed, however, a cyberattack becomes more worrisome. One of the major public heath implications of such an attack is that protected health information is “durable” unlike, say, a credit card number that can be changed if the card is stolen or lost. However, medical history can be used to identify a patient years after the initial data breach, the researchers said.
Attackers could also manipulate patient data, such as potassium values, which could cause serious harm to patients’ health. Similarly, attackers could manipulate clinical systems like medical devices.
How organizations can reduce risk
While the researchers acknowledged that the challenge of protecting the healthcare industry from the rising number of threats is “complex” and that although there is no “silver bullet” that can stop all attacks, there are things organizations can do to reduce their risk.
Healthcare organizations should use best practice security procedures such as software update and data encryption, as well as do frequent backups. Improving password security by requiring frequent password changes can also help keep attackers out of a hospital system.
Finally, educating healthcare professionals about how attacks occur — such as clicking a malicious link in an email — can help reduce risk as well.
The researchers’ comments echo those of the Health Care Industry Cybersecurity Task Force, which called healthcare cybersecurity a “public health concern” that required “immediate and aggressive attention.” The task force outlined six imperatives to address the public health implications of cyberthreats, including improving awareness and education and developing a workforce that prioritizes cybersecurity.
Healthcare has had its sights set on transitioning over to value-based healthcare for a while now. But moving beyond the current fee-for-service care delivery model has proven challenging. Despite these challenges, some experts believe that value-based healthcare’s reliance on data and data analytics has exciting implications for health IT. Two lawyers share their four predications for value-based healthcare and digital health technology in a Law 360 article.
1) Raw data gains value from value-based healthcare tech
What with EHRs, HIEs, clinical decision-making tools and more, healthcare is generating a massive amount of data, the article said. In order to effectively use and take advantage of these tools, raw data needs to be collected from multiple sources and analyzed in one place.
2) Focus will turn to data sharing
Data sharing will become essential to value-based healthcare, the article said. This, in turn, will motivate those who collect, de-identify, aggregate and analyze clinical data, and the providers who generate the data to further share information. The article warns healthcare vendors and providers that, although data sharing is a positive force when it comes to value-based healthcare, these stakeholders should first consider whether patient authorization is necessary (in some cases it is and in other cases, legally, it is not), whether a provider is required to modify and redistribute its notice of privacy practices, and whether business associates should be handling PHI.
3) The market will be driven by evidence-based and HIPAA compliant tech
Currently, many developers focus on creating healthcare technologies that are patient-facing and wellness-oriented, the article said. This means that the companies creating these tools can avoid regulatory scrutiny, the article explained. However, value-based healthcare may change all that, especially since population health and patient engagement are key factors to successfully achieving value-based healthcare. As providers begin to use these tools, such as an app for their patient to use to document clinical information, the vendors creating these apps and healthcare technologies will then have to ensure their product is HIPAA compliant.
4) Employers take center stage
Employers are the primary purchasers of healthcare and will continue to be, according to the article. This means that employers will also likely greatly influence the use of health IT. Employers have said they want to make telehealth services available to employees, the article said. Furthermore, employers view these wellness programs as cost saving measures and the article said that health IT will facilitate this growth.
The Department of Health and Human Services will award $195 million to community health centers to expand substance abuse and mental health services that focus on awareness, prevention and opioid treatment in the U.S. The award will help health centers leverage health IT and training to support the expansion of mental health and substance abuse services, and integrate those services into primary care, according to an HHS release.
The funding will also increase the number of personnel for substance abuse and mental health services, according to an HHS release.
HHS Secretary Tom Price said integration is key to solving the challenges of mental illness and the opioid epidemic, and that the funding would help health centers across the country provide integration for mental health services to aid in opioid treatment.
One health IT tool that community health centers may utilize is the Behavioral Health Provider EHR Readiness Assessment Toolkit, which was developed specifically for substance use and mental health treatment. The toolkit can help health centers adopt certified health IT, as well as telehealth, social media, mobile technologies and other information technology. These technologies can be used to spread awareness or provide remote services to patients who may be dealing with behavioral health issues.
Health IT has the potential to have a positive impact on opioid treatment, other substance abuse care and mental health services, especially in rural or underserved areas where access to those services may be limited. However, it is important to balance health IT with actual providers because there are aspects of healthcare — especially behavioral and mental health — that still require a human touch.
Applications for HHS’ Access Increases for Mental Health and Substance Abuse Services award must be submitted by July 26, 2017, and funding is expected to be awarded in September.
Last week, SearchHealthIT discussed how the Health Care Industry Cybersecurity Task Force declared cybersecurity a public health issue. This week, SearchHealthIT takes an in-depth look at the six imperatives laid out by the cybersecurity task force.
The Health Care Industry Cybersecurity Task Force (HCIC Task Force), created by Congress as part of the landmark Cybersecurity Act of 2015, gathered information from external stakeholders and subject matter experts from across the healthcare industry, as well as other sectors, to better understand what changes need to be made and what goals need to be achieved in order to improve cybersecurity in healthcare.
In a report, they list six cybersecurity imperatives:
Better define leadership, governance, and expectations for healthcare cybersecurity
There are many opportunities for confusion when it comes to cybersecurity in healthcare, the report said.
“The technical infrastructure underlying health systems is inordinately complex. It must support not only patient records but also a diverse suite of medical devices used in diagnosing, monitoring, and treating patients,” the report said. “Understanding and managing cybersecurity risks for this mission-critical environment is challenging as the healthcare system has a mixture of state-of- the-art applications and devices, as well as older legacy devices that use unsupported operating systems or networking protocols.”
Furthermore, there are multiple frameworks for addressing cyber risk, the report said. This only adds to the confusion and the opportunity for vulnerability.
Because of these complexities and confusions, the cybersecurity task force said in their report that a consistent cybersecurity framework is needed.
The task force also recommended creating a cybersecurity leadership role within HHS.
Increase the security and resilience of medical devices
The report explains that there is a misalignment when it comes to medical devices and other healthcare technologies. For example, operating systems and other platforms such as commercial off-the-shelf software are misaligned with medical devices and electronic health records (EHRs), which can be utilized for 10 to 20 years or more.
“Some foundational challenges that will need to be addressed in order to enhance the cybersecurity of medical devices and EHRs include legacy operating systems, secure development lifecycle, strong authentication, and strategic and architectural approaches to product deployment, management, and maintenance on hospital networks,” the report said.
Develop healthcare workforce to prioritize cybersecurity
The cybersecurity task force said in their report that there are several challenges to creating a healthcare workforce that will prioritize cybersecurity:
- Finding people and tools to address the small and medium-sized healthcare organizations which usually can’t afford full-time technical resources.
- Limited resources for reinvestment in cybersecurity, especially for small and medium-sized organizations.
- Identifying cybersecurity leadership roles to identify risk.
- The growing involvement of patients in their own care also increases the exposure to threats.
Improve cybersecurity awareness and education
The report suggests three action steps the healthcare industry should take to achieve awareness and education:
- “Increase outreach for cybersecurity across all members of the health care workforce through ongoing workshops, meetings, conferences, and tabletop exercises.
- “Provide patients with information on how to manage their health care data by developing consumer grading systems for non-regulated health care services and products.
- “Develop cyber literacy programs to educate decision makers, executives, and boards of directors about the importance of cybersecurity education.”
Identify mechanisms for protecting from attacks and exposure
The Task Force recommends doing this by developing guidance for the industry on creating economic impact analysis and loss for cybersecurity risk, and researching how to protect healthcare big data sets.
Improve sharing information about industry threats, risks, and mitigations
“Together, industry and government should work together to ensure that the best resources are leveraged from the various systems and tailored toward the unique needs of health care while protecting privacy and maintaining appropriate legal protections,” the report said.
A federal task force called healthcare cybersecurity a “public health concern” that needs “immediate and aggressive attention,” and said increased digital connectivity places a greater responsibility on healthcare organizations to secure their equipment and patient data.
After a record-breaking year of data breaches last year, experts have predicted that the healthcare industry will increase cybersecurity spending in 2017. Threats to cybersecurity for healthcare facilities range from technical exploits such as ransomware to insider threats such as employee negligence. Both types of threats can potentially expose patient data and leave it susceptible to fraud and identity theft.
To address these and other challenges of cybersecurity for healthcare, Congress established the Health Care Industry Cybersecurity Task Force. In a recent report to Congress, the task force used information gathered from briefings, public meetings and expert consultations to identify six imperatives to help improve cybersecurity for healthcare as an industry.
- Define and streamline leadership, governance and expectations for healthcare industry cybersecurity – A single person should be responsible for coordinating cybersecurity activities within and outside of HHS.
- Increase the security and resilience of medical devices and health IT – Ensure that legacy systems are secured and track medical device vulnerabilities.
- Develop the healthcare workforce capacity necessary to prioritize and ensure cybersecurity awareness and technical capabilities – Identify cybersecurity leadership within an organization with the authority and expertise to prioritize cybersecurity issues and initiatives.
- Increase health care industry readiness through improved cybersecurity awareness and education – Develop programs geared toward executives and boards of directors about the importance of cybersecurity education.
- Identify mechanisms to protect research and development efforts and intellectual property from attacks or exposure – Develop guidance for the healthcare industry and academia to evaluate cybersecurity risks for healthcare R&D.
- Improve information sharing of industry threats, weaknesses, and mitigations – Streamline the sharing of cybersecurity information and guidance to make it easier to use for small and medium-sized healthcare organizations.
The task force also identified best practices from the financial services and energy sectors, including conducting comprehensive information sharing and implementing baseline protections, such as patching systems against known vulnerabilities. The task force also recommended boosting communications and collaboration across the industry in order to educate portions of the sector that may not have had access to information about the latest threats to cybersecurity for healthcare organizations.
Health IT experts have lauded the benefits artificial intelligence (AI) will bring to healthcare for some time now. They range from improving cybersecurity to improving the workflow of a hospital. However, only the wealthiest countries and wealthiest healthcare organizations are able to purchase and use AI technologies.
Margaret Chan, director general of the World Health Organization (WHO) said at an AI summit that this technology must benefit everybody, not just the wealthiest countries and organizations, according to a Wired article.
“Enthusiasms for smart machines reflect the perspectives of well-resourced companies and wealthy countries,” Chan said in the article. “We need a wider perspective.”
Chan illustrates this disparity and how, quite frankly, silly AI technologies seem to those who don’t even have electricity and running, clean water.
“Any discussion of smart machines revolutionizing healthcare must be alert to these huge gaps in capacities,” Chan said in the article.
However, Chan said one thing everyone has in common regardless of wealth is the need to address chronic diseases such as heart disease, diabetes and hypertension. Here is where Chan believes AI technologies and wearables could provide great value.
In addition to addressing the disparity issue, Chan also warned against the over-reliance on technology, asserting that while machines will aid doctors in their work and streamline processes that lead to decisions, technologies like AI will never replace doctors and nurses when it comes to their interactions with patients.
Furthermore, Chan said that sometimes these technology tools give a false sense of safety and security. “Wearables for monitoring cardiovascular performance are already being questioned,” she said, for example.
In addition to disparity issues and warning against over-reliance of technology, Chan also pointed out that when it comes to AI technologies there are also many regulatory issues that need to be addressed.
“What if a smartphone app misses a symptom that signifies a severe underlying disease?” Chan said in the article. “Can you sue a machine for medical malpractice?”
Chan said that medical devices are heavily regulated for good reason but how can a machine be programmed to think like a human? She pointed out that doctors and nurses are not only licensed to practice medicine but also undergo continued study.
But with AI, there are many questions, she said. “We do not have the answers to many questions around AI. We’re not even sure we know all the questions that need to be asked.”