Health IT Pulse


February 9, 2016  4:23 PM

ONC says HIPAA doesn’t impede health IT interoperability

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
HIPAA, HIPAA Compliance, Interoperability, OCR, ONC, PHI

Officials at ONC are determined to smother the notion that HIPAA and its PHI regulations interfere with providers’ capacity to exchange patients’ health information. At least that’s the implication behind a collection of educational resources being published and promoted by ONC.

In response to frequent complaints that HIPAA stifles the transmission of patient data between provider networks, Lucia Savage, chief privacy officer at ONC, and Aja Brooks, ONC privacy analyst, co-authored an introductory blog post that outlines a forthcoming informational series from ONC. The four-part blog series will cover the following areas of HIPAA:

  • Part one will discuss the permitted uses and disclosures, or situations in which HIPAA covered entities aren’t required to obtain authorization from a patient before sharing their PHI.
  • Part two will define permitted uses and disclosures and explain how they support interoperability.
  • Part three will provide examples of health information exchange from provider-to-provider and between providers and payers.
  • The topic of the final part of the series will be the interoperable passage of PHI for quality assurance and population-based activities.

Two fact sheets were mentioned in the ONC’s blog post and were created with input from the HHS Office for Civil Rights (OCR), the agency that enforces the HIPAA Privacy and Security Rules. The fact sheets detail scenarios in which a patient’s PHI can be shared between two covered entities without first needing permission from the patient. PHI can be shared for healthcare operations purposes such as during clinical quality assessments or patient safety activities. Providers are also allowed to exchange PHI when referring a patient or coordinating care with another covered entity, according to the ONC and OCR resources.

This blog series on HIPAA and the open exchange of patient information aligns with ONC’s recent push for more health IT interoperability. The Shared Nationwide Interoperability Roadmap, released by ONC a year ago, plots out a 10-year path for U.S. providers to operate within an interoperable health IT infrastructure. The goal of that roadmap is for information to flow easily between providers so they can improve the quality of their care. With the publication of its series of blogs, ONC is seemingly making a statement that providers can no longer use their fear of HIPAA violations as an excuse for not joining the health IT interoperability movement.

February 4, 2016  9:48 AM

Technology may not be helpful with tracking Zika virus

Kristen Lee Kristen Lee Profile: Kristen Lee
Ebola, WHO

The World Health Organization (WHO) has officially declared the Zika virus a global health emergency and now hospitals are on alert and prepping for any incoming cases, and the public is being informed of symptoms and proper precautions to take.

Although technology helped in tracking the spread of Ebola with an Ebola reporting app, the Zika virus is a health problem for which technology may not be as helpful when it comes to tracking and building predictive models, a DC Inno article reported.

With the Ebola virus, the CDC was able to build a mobile application called the Epi Info viral hemorrhagic fever (VHF) application. The app enables people to input information related to individuals who have been exposed to the contagious disease, including information such as names, gender, age, location, patient status and case classification. Ultimately, this allowed for easier and rapid delivery of patient reports that included location and condition information, the article said. This, in turn, enabled organizations like the WHO to build more accurate predictive data models.

But tracking people and tracking mosquitoes are two totally different issues.

First, they are two vastly different viruses that result in varying symptoms and outcomes for those who are infected. The biggest difference between the two viruses is how they are spread among humans. Ebola is spread through human contact while, in most cases, Zika is spread by mosquito bites. Either way, they are both headline-setting viruses that have affected and are affecting large numbers of people. Therefore, forecasting the viruses spread is critical.

The “CDC is working on modeling activities,” Candice Hoffmann, a press officer with the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, told DC Inno. “However the limited amount of available data on Zika virus infection makes this challenging.”

Zika symptoms are difficult to spot and sometimes don’t even appear in some patients. Therefore, reliable reporting usually lags behind regional outbreaks, the story said. As a result, models can’t be accurately updated even though technology is more available in the Americas, where the Zika virus is most prevalent right now, than there is in West Africa where Ebola was most widespread.

Ronald Klein, the lead coordinator for the U.S. response to the Ebola epidemic and known as the “Ebola Czar”, also told DC Inno that no matter how advanced the software, the models generated are only as good as the data reports that are inputted to create them.

Modeling for viruses passed from human to human involves the surveillance of things like traditional transportation avenues, while modeling for mosquito-based viruses is dominated by trends like species-specific migratory patterns and regional ecosystems, the article said.

“This type of tracing [within the Ebola app] is not helpful for a vector-borne disease, as [the Zika virus] is spread by mosquitoes and not people,” Hoffman told DC Inno.


February 3, 2016  3:28 PM

American Heart Association goes with health IT

Shaun Sutner Profile: Shaun Sutner
IBM Watson, Wearable devices

The American Heart Association is giving some powerful health IT tools to employers to use in the workplace to improve the heart health of Americans, more than 85 million of whom have cardiovascular disease.

The initiative, in conjunction with IBM’s Watson Health unit and Welltok, Inc., a consumer-oriented population health system vendor, was announced Feb. 1, the first day of American Heart Month.

At the core of the program is the AHA’s new Workplace Health Achievement Index, which the AHA says uses best practices to measure and rank corporate health initiatives and assesses companies on their workplace health culture.

The index came out of the AHA’s CEO Roundtable, a workplace health group representing some of the country’s biggest employers.

The health IT part, which is still in development, \will come by using Watson’s cognitive computing-driven analytics capabilities combined with science-based metrics and health assessments developed by the AHA.

“Watson will uncover cognitive insights by analyzing data from the Index to provide guidance on how an employer can support employee health, such as informing how corporations design, tailor and deliver health benefits and health promotion programs that maximize the health of the workforce,” according to an IBM release detailing its partnership with the AHA.

Under the AHA health IT plan, the Watson system will work with Welltok’s software platform to allow individual employees to participate — online or with a mobile device — in the workplace heart health programs linked to Watson.

Employees can complete AHA’s cardiovascular health questionnaire, My Life Check, which measures key indicators such as not smoking, eating healthily, being physically active, achieving and maintaining a healthy weight, managing blood pressure, controlling cholesterol, and reducing blood sugar.

Welltok will use consumer insights from the questionnaire and data collected by wearable fitness trackers, wireless scales and blood pressure cuffs to help people make healthy choices to reduce their risk of cardiovascular disease.

“With this program, individuals and their employers will be able to benefit from a personalized, cognitive [system] designed to help improve heart health and reduce healthcare costs,” Eduardo Sanchez, M.D., the AHA’s chief medical officer for prevention, said in the release. “Our hope is that we can set a new standard for continuous quality improvement in workplace health.”


February 2, 2016  4:06 PM

Providers see upside of precision medicine, aren’t prepared to use it in patient care process

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
EHR, Genomes, precision medicine

Don’t expect the practice of precision medicine to enter mainstream healthcare in the next five years, at least in non-academic medical settings.

Nearly 60% of respondents to a Health Catalyst survey said precision medicine will not be a major part of their patient care processes between now and 2020. That number increased when singling out non-academic medical facilities, 71% of which said they don’t have plans to include the genomics aspect of precision medicine into their EHR systems.

David Crockett, senior director of research and predictive analytics for Health Catalyst, gave a reason why he believes many non-academic facilities aren’t eager to use precision medicine techniques. “The disconnect between the recognition that genomics holds great promise and yet the lack of preparation for precision medicine may reflect the fact that technology adoption is often driven by research efforts at major academic medical centers, with others following in their footsteps,” Crockett said in the Health Catalyst release.

Though the majority of survey respondents aren’t rushing to begin precision medicine treatment, many of them believe there is some value in studying patients’ genetic variations. Half of them said DNA sequencing — which produces genomics data — could have a positive effect on their organizations’ patient care processes and outcomes.

While many healthcare providers are reluctant to embrace precision medicine A speaker at last year’s Connected Health Symposium in Boston supported the thought that precision medicine could improve treatment for individual patients. Before that happens, Thomas Goetz, co-founder of Iodine Inc., said physicians need to connect with the people they’re treating on a personal level. Goetz hypothesized that precision medicine could be more powerful if medical practitioners and patients were more communicative with each other.

The results of a study performed by University of Utah researchers bolstered the idea that precision medicine can enhance patients’ long-term health. The researchers split patients into two groups, one that received pharmacogenetic testing to measure how well they might respond to medication based on their individual genetics and another group that didn’t undergo that testing. In a subsequent four-month period, the precision medicine group had a hospitalization rate of 9.8%, compared to 16.1% of the control group.

Precision medicine has been the subject of much discussion and action in healthcare. President Barack Obama announced a $215 million investment in precision medicine in early 2015. Those funds went to the National Cancer Institute for analyzing cancer genomics and to The National Institutes of Health, which plans to use the money to create and track the health of a group of one million Americans. Giving financial support to those research institutes — rather than individual healthcare organizations — was probably the right move as most providers aren’t ready to incorporate genomics data into their patient care processes.


January 28, 2016  9:41 AM

Virtual reality: The next frontier for healthcare

Kristen Lee Kristen Lee Profile: Kristen Lee
Virtual Reality

Virtual reality is a computer-simulated environment created with software that can recreate sensory experiences and is presented to the user so the user suspends belief and accepts it as a real environment.

Already popular in film-making and video games, virtual reality technology now is predicted to grow in healthcare in the coming years, according to several reports.

The market for virtual reality in healthcare is expected to reach $1.45 billion by 2020, according to a report by Research and Markets.

And, according to another report by Acute Market Reports, the U.S. is the most popular market for healthcare virtual reality. In 2013, North America had the biggest presence of virtual reality in the healthcare market with an 80% market share, the report said. In the same year, the U.S. held the biggest market share overall (75%). The U.S. healthcare virtual reality market is being driven by strong research, development and investments by the government and private firms, the report indicated.

Not only will this technology become more prevalent in healthcare, but it also has many applications including in psychiatry, training, medical practice, surgery simulation, robotic surgery and others.

In fact, virtual reality is already being used in some hospitals.

One example of how it’s being used is the case of a four-month-old named Teegan Lexcen who was born with one lung, a defective heart, and a slim chance of surviving. Pediatric surgeons at Nicklaus Children’s Hospital in Miami, Florida, took computer scans of Teegan’s heart and lung and uploaded the images onto an iPhone. They then used a $20 Google Cardboard device to view the MRI scans—which they had converted into 3D images—to visualize the procedure they were about to do.

The doctors were able to successfully decide where to make their first incision because of virtual reality imaging. Ultimately, the seven-hour open heart procedure to rebuild Teegan’s aorta went well and she will be ok.


January 27, 2016  3:30 PM

Health data exchange is alive, maybe even getting well, slowly  

Shaun Sutner Profile: Shaun Sutner
FHIR, HIE, Interoperability, KLAS

Health IT market research reports from KLAS Enterprises LLC are super influential. Using hard evidence gathered by KLAS researchers, they show clearly where segments of the market are headed.

The KLAS blog is where executives and researchers from the Orem, Utah-based firm flesh out the larger reports with commentary and, sometimes, details that didn’t make it into the exhaustive final reports.

KLAS founder Kent Gale did just that in a Jan. 25 post that gets into some interesting context surrounding a KLAS interoperability study released last fall.

It turns out that with quite a few interoperability technologies and initiatives actually at work out in the real world, one that is closely associated with the federal government appears to have the most traction, Gale explained.

That one is the Sequoia Project, which runs the eHealth Exchange, a nationwide health information exchange network that was conceived within ONC, but is now run  independently by the Sequioa Project. The Sequioa Project  used to be called “Healtheway,” and many people still refer to it by that name.

In any event, as KLAS was exploring health data exchange connections between providers and some big federal agencies — including the U.S. Department of Veterans Affairs (VA), Social Security Administration (SSA) and the Department of Defense — the eHealth Exchange kept coming up.

Other health data players, including FHIR (HL7’s Fast Healthcare Interoperability Resources standard), Surescripts, and RelayHealth, a McKesson Corp. subsidiary that does health data exchange, also turned up in KLAS’ research, apparently to a lesser extent.

KLAS asked health IT vendors for lists of provider organizations that are their clients and were sharing data with the three big federal agencies.

The results were somewhat spotty, but the Sequoia Project and its eHealth Exchange, showed some vitality, Gale reported.

KLAS asked 240 provider organizations to validate how many provider organizations were successfully sharing patient data with the agencies.

One vendor reported 40 such live connections. KLAS got in touch with those providers, and more than 20 reported they were sharing data with the VA and SSA through the eHealth Exchange.

“Many gave details regarding numbers of transactions and noted the general ease with which the Healtheway connection was put into place,” Gale wrote, employing the old name.. “Fifty percent of the vendors questioned and over 40% of the provider organizations see eHealth Exchange as extremely valuable for the future.

“Our interviews confirmed the live connectivity already in place as well as the intent of many large acute care organizations to implement eHealth Exchange,” Gale continued in the blog post.

So, kudos to the Sequoia Project for a job well done in somewhat consistently accomplishing the difficult feat of sharing patient health information in a still interoperability-challenged health IT world.


January 26, 2016  2:38 PM

Rural physicians keep pace with urban professionals in EHRs, meaningful use

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
EHR, EHR adoption, EHR implementation, meaningful use attestation, rural health care

Though they are often thought to possess fewer resources than their colleagues that practice in different geographic locations, physicians who are based in rural areas have kept up with their urban counterparts when it comes to EHR adoption.

By 2013, 82.3% of rural physicians installed an EHR system. In comparison, only 78% of urban-based physicians had adopted EHRs by the same year, according to a study published in Health Affairs. Data derived from the 2013 National Electronic Health Records Survey and included in the study showed that the greater likelihood of rural ambulatory professionals adopting EHR systems — compared to those in urban settings — extended to numerous groups. Specifically, a larger percentage of rural primary care physicians, nurse practitioners and physician assistants had installed EHRs when measured against urban healthcare employees with the same job titles.

The study also analyzed the levels of success of urban and rural specialists in attesting to meaningful use. Rural professionals were found to have an edge in this regard, as 91% of rural podiatrists, nearly 88% of rural optometrists and roughly three quarters of rural physicians successfully achieved the criteria that make up the meaningful use program. Those figures all exceeded the percentages reported by the same specialist groups that worked in urban settings.

Not every statistic in the survey came back in favor of rural providers, however. The percentage of rural providers that attested to meaningful use and subsequently dropped out of the program for a year between 2012 and 2014 topped the urban number 38% to 34.9%. Critical access hospitals –medical facilities that are at least 35 miles from another hospital, located in a rural area and have an average length of stay of less than 96 hours — that initially met meaningful use standards between 2011 and 2013 represented the group most likely to pass over a year of meaningful use attestation, as 16.4% of them did so.

Meeting the requirements of meaningful use should be easier for critical access hospitals through 2016 and 2017 than in previous years, as a recent update to the program reduced the number of criteria that apply to critical access hospitals from 20 objectives to nine.


January 21, 2016  9:52 AM

Artificial intelligence systems in healthcare in sight

Kristen Lee Kristen Lee Profile: Kristen Lee
Artificial intelligence

Artificial intelligence in healthcare may be closer to becoming a reality than you think. AI market earned revenues in healthcare are estimated to reach $6,662.2 billion in 2021, according to an analysis by Frost & Sullivan. Compare that to the healthcare AI market revenues earned in 2014– $633.8 million—and that’s a compound annual growth rate of 40%, the analysis said.

The need for data mining and decision-making is what is driving these AI-enabled solutions in healthcare, according to the report. The analysis added that AI systems will also strengthen medical imaging diagnosis processes and help deliver better care by improving hospital workflow. AI also has the capacity to extract information from disparate information silos, translate unstructured data sets, and provide tools for natural language processing to allow AI systems to tackle challenges in care coordination.

“Augmenting the expertise of trained clinicians, AI systems will provide an added layer of decision support capable of helping mitigate oversights or errors in care administration,” Harpreet Singh Buttar, transformation health industry analyst for Frost & Sullivan, said in a press release.

Further, the analysis said that AI has the potential to improve medical outcomes by 30% to 40% and cut treatment costs by as much as 50%.

“By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries,” Buttar said. “On a global scale, in regions with high underserved patient populations, AI is expected to play a significant role in democratization of information and mitigating resource burdens.”

However, the release added that more research and fine tuning is needed in order to optimize the use of AI systems for both clinical decision support and workflow logistics in hospitals.


January 20, 2016  4:58 PM

FDA gets tougher on IoT medical device cybersecurity

Shaun Sutner Profile: Shaun Sutner
cybersecurity, FDA, Internet of Things, medical devices

Manufacturers and users of connected medical devices should take steps to ensure the cybersecurity of such devices, the FDA said in a new guidance document.

The draft guidance on is significant because it contains the FDA’s first directives on security issues of Internet of Things (IoT) medical devices for after they are released to the market rather than in the design, manufacturing and FDA approval phases.

In 2014, the FDA provided guidance for pre-market cybersecurity technology and management in medical devices. Last year, the agency issued a safety communication on the security vulnerabilities of two infusion pumps made by Hospira, Inc., which is now owned by Pfizer Inc.

“Cybersecurity threats to medical devices are a growing concern. The exploitation of cybersecurity vulnerabilities presents a potential risk to the safety and effectiveness of medical devices,” the FDA said in a Jan. 15 release. “While manufacturers can incorporate controls in the design of a product to help prevent these risks, it is essential that manufacturers also consider improvements during maintenance of devices, as the evolving nature of cyber threats means risks may arise throughout a device’s entire lifecycle.”

In the release, Suzanne Schwartz, M.D., associate director for science and strategic partnerships in the FDA’s Center for Devices and Radiological Health, said that all medical devices that use software and are connected to healthcare providers’ data networks have security weaknesses.

“Some we can proactively protect against, while others require vigilant monitoring and timely remediation,” Schwartz said.

The guidance also says device manufacturers should participate in an Information Sharing Analysis Organization to exchange information about medical device cybersecurity.

In addition, the FDA guidance says vendors should adopt structured and thorough cybersecurity risk management programs, which should include, among other things:

  • Monitoring cybersecurity information sources
  • Detecting the presence and impacts of vulnerabilities
  • Establishing processes for handling vulnerabilities
  • Defining clinical performance to protect, respond and recover from cybersecurity risk

The FDA is soliciting public comment on the draft guidance. The comment period will be open for 90 days.


January 19, 2016  2:20 PM

More than 100 healthcare organizations commit to ACO model

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
accountable care organizations, ACO, medicare reimbursement, Medicare Shared Savings Program

American patients eager for proof that healthcare providers are invested in treating their conditions as thoroughly and accurately as possible should be encouraged by a recent announcement from the Centers for Medicare and Medicaid Services.

More than 100 new organizations joined Medicare Accountable Care Organizations (ACOs) — programs which are built to incentivize providers for the quality of their care — according to CMS. The pay-for-performance pillar upon which the ACO model rests contrasts the fee-for-service model that formerly dominated the American healthcare landscape.

“We are moving Medicare and the entire health care system toward paying providers based on the quality, rather than the quantity of care they give patients,” Sylvia Burwell, HHS director, said in a release.

Patients aren’t alone in benefitting from providers’ participation in ACOs. A total of 333 members of the Medicare Shared Savings Program, Pioneer ACO program and other ACO groups reported a sum of $411 million saved in 2014. The Pioneer ACO model was remarkably financially efficient that year, as the 20 Pioneer ACOs combined to save $120 million in their third performance year. That savings figure increased from $88 million in year one to $96 million in year two, a progression that suggests the ACO model becomes more effective and profitable as healthcare providers gain more experience operating under its guidance.

The Department of Health and Human Services was behind a few decisions that prodded U.S. providers to consider their ACO options, including its creation of the Next Generation ACO Model. Healthcare organizations that commit to be next generation ACOs are essentially taking their promise to offer improved patient care one step further. Next generation ACO participants will take on more financial risk than members of other ACOs, but they’ll also be in line to pocket more of any resulting shared savings payments.

The expanded financial responsibility that comes with joining an ACO hasn’t discouraged health plans from joining up, according to a recent survey done by HealthEdge. The survey results showed that 80% of health plans that follow Medicare are committed to value-based payment models, up from 50% that said the same in 2011.


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