1. How to find new evidence to back digital health initiatives
We know firsthand about the challenges of collecting evidence that HIT tools are effective – and we are not alone. Experts agree that developing clinical evidence to prove the effectiveness of digital health systems and devices lags far behind the hype. The reason is that the slow academic research process cannot keep up with the rapid pace of technological advancement.
In order to gather better data, academicians and vendors need to collaborate more to help commercial developers verify claims.
- Increased research would ensure that providers are making evidence-based decisions, and not just wasting money or harming patient care.
- Dr. Nick Genes, an assistant professor of emergency medicine at Mount Sinai in New York, wrestles with this evidence issue. He’s found that it’s difficult to get hospitals to consider evidence when making a purchasing decision or implementing software solutions that impact clinical care. He says the rapid pace of development in technology makes it hard to study and quantify effectiveness.
- Technology is developed and deployed too quickly for traditional academic-based research. Genes notes for academics to “meaningfully participate” in the field, they must work with technology companies themselves which means “then they’re branded as conflicted.”
- One possible response would be to embed academics into such companies, or to foster closer collaborations between academia and commercial developers to help verify claims. Genes states a few schools already have moved in that direction.
An example of this is Samsung and the University of San Francisco partnering on a new organization called the Center for Digital Health and Innovation, which plans to do just that.
Source: Modern Healthcare, 8/21/14
2. Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients
In a change of policy, CMS administrator, Marilyn Tavenner announced that Medicare will begin paying monthly fees to doctors who manage care for patients with two or more chronic conditions.
- Beginning in January, Medicare will have to pay monthly fees to doctors who manage care for patients with two or more chronic conditions like heart disease, diabetes and depression.
- Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services says “paying separately for chronic care management services is a significant policy change,” Officials say such care coordination could pay for itself by keeping patients healthier and out of hospitals.
- This payment model is already being used by Medicare HMOs which cover about 30% of Medicare patients.
- About 66% of Medicare patients have at least 2 chronic conditions and treating them accounts for 93% of Medicare spending.
- Doctors will receive about $42 per month per patient, if patients agree in writing, as they will be required to pay 20% of the cost, which is the same percentage they pay for other doctor services.
- The new care management services can be provided not only by doctors but also by nurse practitioners, physician assistants and certain other health professionals. Medicare officials said they expected doctors and other providers to focus on sicker patients with four or more chronic conditions.
Source: NY Times, 8/16/14
3. You can show patients test results, but will they understand them?
As adoption of electronic health records increases, more patients are able to view their lab results electronically outside of clinical consultations, but a study suggests that access doesn’t mean patients understand what they are seeing.
- A team at the University of Michigan published a study that showed wide disparity in patients’ ability to understand out of range lab results. People with low literacy skills and low numerical comprehension were less than half as likely to identify if a lab result was inside or outside the standard range. They were also less capable of determining, based on the test values, whether or not they should contact their doctor, researchers said. Patients with lower numerical comprehension and literacy skills will need innovative data visualizations in order to truly understand their lab results.
- Through an Internet-administered survey, of more than 1,800 adults between the ages of 40 and 70, of whom nearly half were diabetics, responded as if they had Type 2 diabetes. They were shown lab test results for hemoglobin A1c—a common measure for checking blood sugar—along with other blood tests, in addition to being measured on their ability to apply simple mathematical concepts and health literacy skills.
- 77% could identify levels that fell outside of the standard or acceptable range out of those who were assessed as having higher numerical comprehension and literacy skills,
- Out of those with lower numerical comprehension and literacy skills, only 38% could do so.
- Those with higher scores on the numerical comprehension and literacy tests also were more sensitive to the test results insofar as knowing when they should consult with their doctor.
- One motivation behind providing patients with access to their own data is to help them manage their own healthcare, but more research is necessary to decide how best to display this information, according to Zikmund-Fisher.
- Zikmund-Fisher says “Improving how we show people their health data may be a simple but powerful way to improve health outcomes.”
Source: Modern HealthCare, 8/20/14
4. Recent Data Security Breach
How Heartbleed was linked to the CHS data breach
The 206-hospital Community Health System (CHS) announced in an SEC filing that Chinese hackers stole 4.5 million patients’ nonmedical data this spring – including demographic information and social security numbers. CHS suffered the worst electronic records hack in healthcare privacy history. Security experts are attributing the hack to the Heartbleed security vulnerability.
- The hackers used highly sophisticated malware and technology in the criminal attack. CHS believes they were searching for information on medical devices and equipment., but instead stole data on patients who sought care from its physician practices. The massive breach was revealed in an SEC filing on August 18, though the attacks took place in April and June
- Although CHS didn’t cite this, security experts link the hack to the Heartbleed security bug and agree that it’s likely more organizations were made vulnerable from this bug
- Although a patch was available quickly, CHS is a vast organization with 206 hospitals in 29 states so it would have taken time to apply the patch throughout the system, leaving it vulnerable
- Security experts agree that the likelihood is high that there are more healthcare organizations that have been made vulnerable by Heartbleed and other undetected intrusions
- Experts also say it’s difficult to detect whether a Heartbleed intrusion has occurred. Persistent monitoring and analysis of inflows and related outflows from a system is one method to determine whether a system is being hit.
Source: Modern Healthcare, 8/22/14
Source: Modern Healthcare, 8/22/14
Source: Modern Healthcare, 8/18/14
Health system adapts NIST framework to meet security risk needs
Data breaches must lead to a refocusing of thinking and behavior in IT security. Organizations should identify what’s at risk, detect threats as they happen and respond to those threats as quickly as possible.
Christopher Paidhrin, security administration manager in the information security technology division at PeaceHealth in Portland, Oregon says PeaceHealth has taken the National Institute of Standards and Technology framework and adapted it to meet the system’s needs.
Those adaptations, Paidhrin writes, include:
Aligning core functions with the health system’s COBIT Information Security Service Catalog
- Aligning core functions with the health system’s COBIT Information Security Service Catalog
- Identifying risk priorities
- Mapping organizational maturity for strengths, weaknesses and threats
- Making an action plan and remediation roadmap
Paidhrin adds the NIST framework is key because it can be easily adapted to help organizations establish baseline security.
It is vital for healthcare organizations to evolve and prepare for news risks with this recent reveal that the Heartbleed bug helped hackers to access the records of millions of patients at Community Health Systems.
Source: FierceHealthIT, 8/22/14
Graphic of the week: Source