The Joint Commission, the independent nonprofit that functions as a sort of unofficial arm of government healthcare regulatory agencies, has essentially reversed its 2011 opinion on clinician text messaging.
In the May 2016 issue of its Joint Commission Perspectives newsletter, the commission updated its previous guidance on texting. The commission noted that secure text systems were not widely available when it published a 2011 FAQ stating it wasn’t acceptable for physicians and other clinicians to text orders for patient care or treatment to hospitals or other care settings..
“At the time, the technology available could not provide the safety and security necessary to adequately support the use of text messaging for orders,” the commission said.
But, “as technology has evolved, however, the number of secure text messaging platforms has increased,” the commission added.
The commission said that after conducting research it has decided to immediately revise its previous stance. Now, healthcare practitioners can text orders as long as they use secure messaging systems and meet certain requirements of an order.
Approved secure messaging systems must include these functions, according to the commission:
- Secure sign-on
- Delivery and read receipts
- Date and time stamp
- Customized message retention time frames
- Specified contact list for people authorized to receive orders
Organizations that use text orders should comply with medication management standards and also consider how text orders will be documented in patients’ health records and whether they integrate with EHRs.
Meanwhile, the commission advised organizations that allow texted orders to develop an attestation process to document the capabilities of their secure texting technology; define when text orders are appropriate; monitor frequency of texts and assess compliance; develop a risk management strategy and perform a risk assessment; and conduct training.
To sum up the commission’s new position on secure texting: it’s OK, under certain conditions.
The FDA is making an effort to increase medical device interoperability, but their current plan for achieving that objective isn’t comprehensive enough, according to a group of healthcare CIOs and IT executives.
The College of Healthcare Information Management Executives (CHIME) wrote a letter on behalf of its 1,800 health IT executive members to the FDA. The CHIME letter was a response to the FDA’s draft guidance on using medical devices to safely exchange patient data. In the letter, CHIME made it known that it fully supports the FDA’s goal of achieving more medical device interoperability, but expressed skepticism that the recommendations previously issued by the FDA will seamlessly facilitate improved medical device interoperability.
The CHIME letter indicates that even though CHIME members sometimes purchase new software and devices — which are supposedly interoperable — they struggle to connect the new software and devices with their existing systems without the help of a third party.
The following is a list of some of the advice CHIME gave to the FDA as it continues to develop its medical device interoperability policies:
- The FDA should work with ONC, device manufacturers and healthcare providers to establish a defined set of interoperability regulations for medical devices.
- The FDA should also collaborate with ONC to better define interoperability and to certify application programming interfaces.
- Manufacturers should be mandated to annually complete a risk assessment on their devices.
- The FDA should align its interoperability regulations with its existing cybersecurity guidance.
The FDA’s stance on medical device security should be fresh in the minds of device manufacturers, especially since the government agency released a draft guidance on the topic earlier this year. In its release, the FDA stated that all connected medical devices have some cybersecurity vulnerabilities. The FDA urged developers to be aware of the performance of their devices even after they are released and sold so they can help preserve high quality patient care.
Mobile apps in healthcare are here to stay. Indeed, the market for mHealth devices and services market is expected to grow to $50 billion by 2020—up from $14.5 billion in 2014—according to a report from Zion Research.
Furthermore, a purchasing intentions survey SearchHealthIT recently conducted in conjunction with the College of Healthcare Information Management Executives, found that many health IT professionals continue to make mobile a buying priority.
But a study recently published in the Journal of Medical Internet Research (JMIR) mHealth and uHealth found that “risks lie in the enormous availability and low levels of regulations” when it comes to the use of apps and e-tools for medical use.
The study looked at 116 mHealth and e-tools, with 87% of those tools being applications. Of those apps, 16 of them were classified as a type II medical device.
“If we classified a tool as a type II medical device, and if health care professionals were the intended user group, we also examined whether they were accessible to non-health care professionals,” the study said.
Of those 16 tools, seven could be used by non-healthcare professionals.
“Thus, the majority of type II medical device tools designed for use by health care professionals were accessible to the general public,” the study found, noting that this is worrisome when it comes to patient privacy.
And it appears the Department of Health and Human Services has taken note of this potential risk when it comes to apps too. The department recently released guidance for healthcare app developers to aid them in navigating HIPAA.
Precision medicine has a powerful advocate in the person of President Obama.
Now a powerful multinational tech giant is also throwing its considerable financial and intellectual resources behind the movement to use genetics, genomics and big data to provide individualized healthcare.
SAP, the dominant enterprise software vendor, has made a number of moves in precision, or personalized, medicine over the last year that probably make the German-founded company the most visible non-native health IT player in the field.
SAP’s HANA database platform is underpinning the American Society of Clinical Oncology’s CancerLinQ project, a precision medicine-style effort to quickly derive clinical insights from millions of health records and clinical data.
In September 2015, after SAP CEO Bill McDermott lost an eye in a fall at his brother’s home, McDermott declared the company would plunge into healthcare.
Two months later, SAP released two software systems dedicated to healthcare, both built on HANA: Foundation for Health, a warehouse for clinical and data; and Medical Research Insights, a Web-based cognitive computing engine that compares patient data from many sources.
On April 26, SAP sponsored a forum with the Bloomberg Government unit of Bloomberg Finance L.P. in Washington, D.C. dedicated to personalized medicine and President Obama’s Precision Medicine Initiative.
During the symposium, Francis Collins, M.D. director of the National Institutes of Health, explained the initiative’s first major project: a $170 million undertaking to collect the health data and blood samples of 1 million volunteer study participants.
Also this week, SAP released, in conjunction with global forecasting company Oxford Economics, the results of a personalized medicine survey. The survey, Healthcare Gets Personal, shows what SAP calls “the next revolution in healthcare,” one that “promises breakthrough treatments and lower costs.”
SAP and Oxford Economics surveyed 120 health professionals working in personalized medicine and also did in-depth interviews with experts.
Among the top findings:
- Diabetes, already the major illness targeted by precision or personalized medicine, with 45% of respondents reporting it as their main focus today, will grow in two years to be the primary focus of 63%.
- Next was common cancers, with 38% using precision medicine now and 44% expecting to in two years.
- Neurological diseases are targeted by only 33% of precision medicine professionals now. That figure is expected to jump to 58%.
- Respondents also reported they expect major increases in the use of personalized medicine for cardiovascular diseases; aging; autoimmune diseases; rare cancers; and other rare diseases.
- While personalized medicine is already having a measurable effect on patient outcomes, significant adjustments to healthcare organizations’ culture and governance are required. Organizations are still learning how to share new data with patients and are preparing for new government regulations.
- Organizations are making substantial investments in big data and analytics. “Technology is at the heart of personalized medicine,” according to a release accompanying the survey results.
- Business models for personalized medicine are not fully developed, but there is optimism about revenue growth and profitability over the next two years.
Machines are just as capable as humans, if not more so, on almost every level when it comes to diagnosing patients.
Open source machine learning tools and algorithms are able to identify cancer cases with an accuracy rate that is equal to or greater than that of trained humans. Furthermore, these machine learning tools are also able to give diagnoses faster than their human counterparts, according to a study done by Regenstrief Institute and Indiana University School of Informatics and Computing at Indiana University-Purdue University Indianapolis (IUPUI). The machine learning tools diagnosed the cases based on text data from pathology reports.
The Regenstrief and IUPUI researchers analyzed 7,000 text pathology reports and used algorithms and open source resources to forecast whether an individual report was positive or negative for cancer. Their central finding was that a fully automated review done through machine learning was correct at least as often as expert human reviewers.
“It’s no longer necessary for humans to spend time reviewing text reports… A human’s time is better spent helping other humans by providing them with better clinical care,” said Shaun Grannis, M.D., interim director of the Regenstrief Center of Biomedical Informatics, in the release that summarized the findings of the study.
Grannis also theorized that physicians, healthcare systems, HIEs and other healthcare organizations can rely on technology, such as machine learning tools, to interpret the growing amount of patient health information. In the research report, first author Suranga N. Kasthurirathne, a doctoral student at IUPUI, stated that the study’s way of deploying machine learning to identify cancer could be applied to other health conditions.
Machine learning can be helpful in other ways as well. In an interview with SearchHealthIT, John Brownstein, chief innovation officer at Boston Children’s Hospital, discussed how machine learning is incorporated into a disease tracking resource called HealthMap that he helped create. Though it doesn’t help diagnose a particular disease, HealthMap uses machine learning to pinpoint the geographical location of patients with a disease such as dengue fever.
The use cases for the Internet of Things (IoT) in healthcare are many. Indranil (Neal) Ganguly gave three use cases for IoT in healthcare when he spoke with SearchHealthIT at HIMSS 2016: inventory management, workflow optimization, and medical device integration. And healthcare companies are working to create the technology necessary to make IoT happen.
“I think we’re going to see that increase over the next few years dramatically, but in general, hospitals are just scratching the surface with IoT,” Ganguly told SearchHealthIT at HIMSS 2016.
A new report by Allied Market Research backs up Ganguly when he says that the use of IoT will increase dramatically in the next few years. The report predicts that by 2021, the IoT healthcare market will reach $136.8 billion worldwide.
The report attributes this growth—and the continued growth– to various phenomena:
- Accessibility of wearable devices
- The decreasing cost of sensor technology
- The launch of technologically advanced devices such as smart shirts, smart lenses and smart bands
- The rise in rates of chronic diseases
- Demand for cost-effective treatment and disease management
- Better access to high speed internet
- Implementation of favorable government regulatory policies
However, IoT in healthcare is not without its barriers, the report said. High costs of IoT infrastructure, and data privacy and security concerns, to name a few, are some factors that could restrain the market growth.
Despite this, general growth within the world IoT healthcare market is expected to continue. The report projected that the fastest growing segment would be devices, that patient monitoring will continue to dominate, Fitness and wellness measurement applications will keep growing, and healthcare providers and patients will continue to lead the market.
The use of technology in healthcare is no longer a concern for only the physicians and other staff members responsible for operating the tech. Patients are also preoccupied with the structure of health IT systems and anxious that the negative performance of those systems may interfere with how they are treated.
The ECRI Institute, a medical testing organization based in Plymouth Meeting, Pa., created its third annual list of the top 10 patient safety issues at healthcare organizations. Heading up the list — and beating out processes more directly associated with patient care, such as the inadequate cleaning of flexible endoscopes and medication errors — was the matter of health IT systems not working cooperatively.
Healthcare facilities that install a new technology and hope for the best without making any post-implementation adjustments could be unknowingly contributing to patients’ anxiety about health IT. In a release, Robert C. Giannini, patient safety analyst and consultant at the ECRI Institute, summarized these occurrences and said “after the implementation, people continue to do things the same way and really don’t adjust the health IT system or their workflow.”
A pair of other healthcare safety issues appearing in ECRI’s top 10 list could involve IT systems. Patient identification errors were found to be common and serious, according to ECRI research. Insufficient reporting of test results and follow-up care was another patient safety dilemma noted by ECRI.
Last year’s ECRI top 10 list also contained a few items that linked inadequate health IT performance to substandard patient safety. The integrity of patient data held within health IT systems, such as EHRs, was called into question, as was the malfunctioning of patient-handling devices. Cybersecurity snuck onto the list as well and, according to a recent TechTarget survey on health IT buying intentions for 2016, it remains a priority for health IT professionals. More than half of the 181 employees that responded to the survey said reinforcing their compliance and security practices will be the primary focus of their spending this year.
Three companies that are playing key roles in the transformation of healthcare via technology were spotlighted in a recent Merrill Lynch RIC (Research Investment Committee) Report.
Those companies are IBM, Apple, and Fitbit.
According to the April report, which contains annual and long-term forecasts as well as other important trends, the three tech giants were singled out because they are positioning themselves to be leaders in predictive analytics and big data in healthcare.
Their “ability to leverage the available data to drive insights is pivotal,” the report said.
IBM is distinguished because of Watson, a supercomputing system that combines artificial intelligence and sophisticated analytical software. IBM has taken Watson into the healthcare space with Watson Health.
Merrill Lynch also noted that not only have IBM’s shares risen in 2016, but also that Watson can take massive amounts of data from many sources, run it through analytics and from there derive insights.
Watson can aggregate data on chemical properties and structures, as well as genetic, metabolic and proteomic information, and perform research on more than seven million diseases. Watson can also mine data to identify patterns more easily than conventional systems.
Although some may think Apple was featured in the report because of the Apple Watch, that’s only part of the story. The report focused on Apple also because the company has established stringent privacy controls and because it is a key player in mass aggregation of health-related data. Think about not only the Apple Watch but also the Apple Health app, HealthKit and ResearchKit. Altogether, these applications help make large scale storage and analysis of health data possible, the report said.
Merrill Lynch’s analysts also noted that the Apple Watch is an important component of Apple’s attempted penetration into the healthcare industry.
Fitbit is an industry leader in wearable fitness trackers and the report notes that the products’ social features help users become more active, get more exercise, sleep better and eat healthier. Fitbit trackers have also proliferated in the workforce. Fitbit’s corporate wellness program now has more than 1,000 corporate customers; the report noted that the total market could reach $10 billion by 2020.
Furthermore, Fitbit has partnered with two of the largest U.S. health insurers, the report said, for two early stage programs. One focused on diabetes management and the other on weight management.
The seemingly constant volley of cyberattacks on healthcare data networks is being accompanied by a flurry of new surveys and studies confirming that the threat to health data is real and dangerous.
The latest report on the cybersecurity pandemic comes from data security company Vormetric, Inc., in partnership with the 451 Research firm.
The Healthcare Edition of the 2016 Vormetric Data Threat Report, released April 13, surveyed 1,100 senior IT security executives at large enterprises worldwide, including about 100 in U.S. healthcare organizations, and found that 63% of health IT security professionals have experienced a breach and 20% had a breach last year.
Also, 96% of the healthcare respondents reported they feel vulnerable to threats to their data networks.
Compliance with federal security and privacy laws was the top security spending priority for 61% of the health IT respondents, ahead of preventing data breaches (40%).
But even though 69% of those surveyed by Vormetric and 451 Research that work in healthcare said meeting compliance standards was a “very” or “extremely” effective way to secure data, “compliance is only a step toward healthcare IT security,” according to Garrett Bekker, a 451 information security senior analyst.
“As we learned from data theft incidents at healthcare organizations that were reportedly HIPAA compliant, being compliant doesn’t necessarily mean you won’t be breached and have your sensitive data stolen,” Bekker said in a .
Bekker said in the release that while security professionals in healthcare are still spending heavily on network and endpoint security, they are not using enough technologies that help guard data once perimeters have been breached.
Some 54% of those surveyed said the top challenge in instituting effective cybersecurity defenses was complexity of deployment, but a lack of staff (38%) and budget (30%) were also key impediments.
The survey also showed that many healthcare organizations are moving to store data in the cloud, despite persistent security concerns, and are also using Internet of Things environments that are also seen containing many security vulnerabilities.
Computerized physician order entry systems might help cut down on medical transcription mistakes, but when it comes to flagging drugs that could be potentially harmful to the patient, the systems often makes mistakes, analysis of a survey found.
The analysis was done by Castlight Health on the results of a hospital survey conducted by the Leapfrog Group, which is a nonprofit organization dedicated to healthcare quality and safety. Castlight found that in hospitals that have implemented computerized physician order entry (CPOE) systems, 39% of drug orders that could potentially harm patients weren’t flagged by the CPOE system as a warning to hospital staff. In addition, 13% of possibly fatal medication orders went unnoticed by CPOE systems.
“Hospitals spend millions of dollars to implement CPOE systems, but our results clearly show that many hospitals’ systems are not operating as well as they should, putting patients’ lives at risk,” Leah Binder, president and CEO of Leapfrog, said in a release.
Though CPOE systems don’t detect every possible prescribing error, the majority of CPOE technology adequately functions as a safety net for physicians and other medical professionals. Nearly two-thirds of U.S. hospitals satisfied Leapfrog’s CPOE quality standards which specify that a hospital use a CPOE system for at least 75% of its medication orders and that its CPOE system notify physicians of at least 50% of serious prescribing errors.
However, the performance of CPOE technology varies greatly among the U.S. states. Only 25% of hospitals in Indiana, the lowest percentage in the survey, have systems that met Leapfrog’s CPOE quality specifications. Nevada came in second-to-last, with 35% of its hospitals hitting Leapfrog’s targets. Conversely, more than 80% of hospitals in Maine, Georgia and New York did the same.
Another trend that came out of the Leapfrog survey was the near-universal adoption of CPOE systems. In 2015, 96% of U.S. hospitals had CPOE systems, which was a drastic increase from 33% of hospitals in 2011.