News Blog

JAMA analysis supports EHR use safety
Tuesday, March 27, 2018

  • Concerns that EHRs may contribute to patient harm are real but, according to one research letter published in JAMA on Tuesday, the actual number of incidents appears to be extremely low.
  • Of 1.7 million safety reports, just 1,956 (0.11%) named an EHR vendor or product and potential patient harm and 557 (0.03%) specifically suggested EHR usability factored into the problem.
  • The analysis includes reports from 2013 through 2016 on 571 Pennsylvania-based healthcare facilities and a large academic healthcare system outside the state. Only reports that mentioned one of the top five EHR vendors or products and noted possible harm were included.


The truth about medical bankruptcies
Tuesday, March 27, 2018

Pop quiz: What percentage of bankruptcies in the United States are caused by medical bills?
If you lived through the debate over passing Obamacare, you probably answered something like “half.” That was the figure in common currency among advocates of health-care reform; then-Sens. Chris Dodd (D-Conn.) and Hillary Clinton (D-N.Y.) were just two of the prominent advocates who used it. Other variants were also popular; Barack Obama, for example, was fond of saying that “the cost of health care now causes a bankruptcy in America every 30 seconds.”
It’s a memorable number. But it’s almost certainly many times the true count.

The figure was based on a series of papers released by a team including Sen. Elizabeth Warren (then a professor at Harvard Law School) and co-authors David Himmelstein and Stephanie Woolhandler of Physicians for a National Health Program. Theirs was hardly the only paper to attempt an estimate of medical bankruptcies, but no one else got eye-popping numbers like that — or nearly so much attention from the media.

Critics at the time, including me, pointed out that there were all sorts of problems with the data, but none of the critiques had the viral charms of the original study. But behind the scenes, the debate has continued. And last week, the New England Journal of Medicine published a new estimate done by a team of health and labor economists.
Their method is considerably more robust than the one adopted by Warren et al., who looked at the presence of medical bills in bankruptcy filings. The problem with doing that is that bankruptcy tends to be multi-causal. If you have a half-million-dollar house, three luxury cars, a boat — and also a heart attack — which of these things “caused” your bankruptcy?
More: 2018-03-27 Healthcare Dive [issue:14626]&utm_medium=email&utm_source=Sailthru&utm_term=.67a7910043ee   ...

Without Context Or Cushion, Do Online Medical Results Make Sense?
Tuesday, March 27, 2018

As she herded her two young sons into bed one evening late last December, Laura Devitt flipped through her phone to check on the routine blood tests that had been performed as part of her annual physical. She logged onto the patient portal link on her electronic medical record, scanned the results and felt her stomach clench with fear.
Devitt’s white blood cell count and several other tests were flagged as abnormal. Beyond the raw numbers, there was no explanation.
“I got really tense and concerned,” said Devitt, 39, a manager of data analysis who lives in New Orleans. She immediately began searching online and discovered that possible causes ranged from a trivial infection to cancer.
“I was able to calm myself down,” said Devitt, who waited anxiously for her doctor to call. Two days later, after hearing nothing, she called the office. Her doctor telephoned the next day. She reassured Devitt that the probable cause was her 5-year-old’s recent case of pinkeye and advised her to get tested again. She did, and the results were normal.
“I think getting [test results] online is great,” said Devitt, who says she wishes she had been spared days of needless worry waiting for her doctor’s explanation. “But if it’s concerning, there should be some sort of note from a doctor.”
Devitt’s experience illustrates both the promise and the perils of a largely unexamined transformation in the way growing numbers of Americans receive sensitive — sometimes life-changing — medical information. A decade ago, most patients were informed over the phone or in person by the doctor who had ordered testing and could explain the results.

More: 2018-03-27 Healthcare Dive [issue:14626]&utm_term=Healthcare Dive   ...

Telehealth Billing Compliance: Medicare Says Goodbye to the GT Modifier
Tuesday, March 27, 2018

For over a decade, Medicare has required providers to append special modifiers to their CPT and HCPCS codes when billing for telehealth services. The two primary modifiers for telehealth services were GT (indicating the service was delivered via an interactive audio and video telecommunications system) and GQ (indicating the service was delivered via an asynchronous telecommunications system). Effective January 1, 2018 that has changed because CMS has decided to largely eliminate the requirement to use the GT modifier on telehealth claims.
Instead of using the GT modifier, providers must mark their telehealth services claims with “Place of Service (POS) 02.” A POS code is required on professional claims for all services – telehealth or otherwise – and using POS 02 signals to Medicare that the service was provided via telehealth. Previously, providers were instructed to use the POS code for where the patient was located at the time of the service. Effective January 1, 2018, POS 02 is to be used for all telehealth services under Medicare. The introduction of POS 02 rendered it unnecessary to also require the distant site practitioner report the GT modifier on the claim.

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Former telemedicine leader cofounds AI, robotics, automation group to support healthcare industry adoption
Friday, March 23, 2018

The former CEO of the American Telemedicine Association, Jonathan Linkous, has joined forces with medical textbook and journal publisher Mary Ann Liebertto launch a group to help healthcare organizations address the challenges of implementing advanced technology from artificial intelligence and automation to robotics.
The new group comes into being at a time when machine learning, a form of AI, is becoming more widely used or at least piloted by the healthcare sector, as health tech companies adopt different ways to use it to speed up analysis of large amounts of data. But adoption has been limited by the need to better understand how the algorithms behind machine learning tools arrive at their analysis.
The Partnership for Artificial Intelligence and Automation in Healthcare (PATH) is designed to bring together health systems, payers and regulators to find how these technologies can improve the delivery of medicine, reduce costs and expand access to healthcare services to millions of people across the globe, according to a news release from the new group.
The group plans to highlight emerging innovations so as to improve understanding of these new technologies and how they can be harnessed to advance patient care. PATH also plans to establish priorities for navigating barriers such as regulatory hurdles, provider and consumer acceptance, and payer policies, according to its website.
“AI and related innovations have already enabled industries such as banking, aviation, and entertainment to grow, provide higher quality products, and allow consumers greater choice,” Linkous, PATH CEO, said in the news release. “With spiraling costs, increasing need, decreasing resources, and rapidly advancing technologies, healthcare desperately needs to catch up.”

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Study highlights how EHR data can pinpoint undiagnosed genetic diseases
Friday, March 23, 2018

A new study out of Vanderbilt University Medical Center found genetic data in electronic health records can be used to spot undiagnosed diseases.
The research, which was recently published in Science, was authored by 27 individuals.
They believed people diagnosed with conditions like infertility, kidney failure, stroke and heart failure could actually have a rare genetic disease.
Thus, the researchers assigned scores to 21,701 people depending on how well their symptoms fit with a description of 1,204 genetic diseases. Patients included were taken from BioVU, a collection that links DNA samples to de-identified EHRs. The researchers replicated the results at a Marshfield Clinic biobank.
Overall, the study found 18 associations between genetic variants and high phenotype risk scores.
The researchers also learned that 14 percent of individuals with genetic variants impacting the kidney had kidney transplants. Ten percent with another variant had liver transplants. These transplants could have been avoided had the underlying genetic cause been disclosed. Instead, patients could have undergone another treatment to prevent the symptoms from worsening.

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How the current healthcare mindset is preventing wider digital health adoption
Friday, March 23, 2018

Although digital health and telemedicine are gaining speed, the industry as a whole has been slow to implement technologies.
A survey from Sage Growth Partners found 44 percent of healthcare executives have not yet adopted telemedicine at their organization, and a report sponsored by Avizia said 82 percent of consumers don’t use telehealth.
A March 21 webinar hosted by VSee took a closer look at the barriers to wider adoption.
“In medicine, things go at a very different pace than in technology and science,” Dr. Homero Rivas, an assistant professor of surgery and the director of innovative surgery at Stanford University, said during the webinar. “The business model that we have had [in healthcare] hasn’t really changed. Medicine itself is not scalable.”
Why does healthcare take so long to innovate? Rivas said part of it has to do with the mindset of the industry and of physicians.
Most entrepreneurs are willing to take plenty of risks. Doctors, on the other hand, are risk-averse. They’re taught not to fail, as it may bring harm to a patient.
“If you always follow dogmas saying ‘You have to do it this way,’ then the innovation will go at a very slow pace,” Rivas said.
Medical school curriculum contributes to the lack of fast adoption, too. “Very, very few medical schools or nursing schools will actually include things such as mobile health or digital health or telemedicine,” he noted.



Controversial Duty-Hours Trial (Mostly) Backs Flexible Hours
Friday, March 23, 2018

Educational outcomes in hospitals' intern-residency programs that set no limit on the duration of trainees' work shifts did not differ from those in standard programs limiting shifts to 16-28 hours, the cluster-randomized iCOMPARE trial found.
There was no significant differences between groups in how interns spent their time, nor was there a difference in how interns perceived the balance between their clinical demands and their education, reported Sanjay V. Desai, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

But a separate survey of trainees in flexible and standard programs showed more dissatisfaction with other aspects of the programs allowing longer hours, including educational quality and overall well-being. At the same time, directors of flexible programs said the educational quality was improved.
The results were presented at Academic Internal Medicine Week in San Antonio, and published online early in the New England Journal of Medicine.

More: Medicine


Ask a Millennial Doc: How Can I Use Social Media Better?
Friday, March 23, 2018

The way information is exchanged among physicians is constantly changing in the social media age. In this exclusiveMedPage Today video, Manasi Agrawal, MD , a gastroenterology fellow at Montefiore Medical Center in Bronx, N.Y., breaks down everything the millennial physician should know about using social media to get up-to-date information, share ideas, and network .
Following is a transcript of her remarks:
Being a millennial physician is very different, I think, from the experiences that people may have had 10 or 20 years ago because the resources available to us and the challenges that we experience are very different, specifically living in a world of social media, the way we exchange information, study ideas and research and the way we network is, in big part, through social media, and that has a huge impact on everyone, including physicians.
I use social media to share my research ideas, to share impactful studies, abstracts, and the important work that I come across in researching things, and to network . I follow physicians who are in the same field that I am interested in -- who, themselves, share impactful studies -- and I routinely check my Twitter feed. This is a great source of learning for me on a daily basis because I come across new studies, new work, and impactful ideas, and then that stirs up more conversations as other people read them. It encourages a lot of communication back and forth. In addition to reading textbooks and journals, this is a great source of learning and staying up to date with what's happening around the world.

More: Medicine


How Docs Could Respond to Disasters Remotely
Friday, March 23, 2018

Telemedicine can help, but we need to recognize its limitations

In post-Maria Puerto Rico, the smell of diesel exhaust hung in the air. A short visit taught me more about island life after the storm than I could have learned from endless hours of cable news or social media. Our patients' voices were a combination of anxiety, exhaustion, and hope.

Some disaster responders, though, can now help from a far greater distance. The universe of telemedicine is expanding, thanks to improved networks and better models of care. Leveraging telemedicine's potential during traditional disaster response suddenly seems like a no-brainer. We're poised to move forward boldly but intelligently in creating a tele -response model for both the acute response phase and longer recovery periods.
After a large-scale event, doctors offices close, kids need pediatricians, and downloading a mobile health app may offer nearly immediate care when none exists otherwise. Telemedicine links can be established by local teams to provide real-time care remotely. The model promises a valuable synergy when tele-health providers partner with historically strong organizations like the American Red Cross.

More: Medicine


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