July 30,2014


A virtual rehabilitation program after amputation: a phenomenological exploration.

Disabil Rehabil Assist Technol. 2013 Nov;8(6):511-5

Authors: Moraal M, Slatman J, Pieters T, Mert A, Widdershoven G

Abstract. PURPOSE: This study provides an analysis of bodily experiences of a man with a lower leg amputation who used a virtual rehabilitation program. METHOD: The study reports data from semi-structured interviews with a 32-year veteran who used a virtual environment during rehabilitation. The interviews were analyzed using interpretative phenomenological analysis (IPA). RESULTS: During this rehabilitation program, he initially experienced his body as an object, which he had to handle carefully. As he went along with the training sessions, however, he was more stimulated to react directly without being aware of the body's position. In order to allow himself to react spontaneously, he needed to gain trust in the device. This was fostered by his narrative, in which he stressed how the device mechanically interacts with his movements. CONCLUSION: The use of a virtual environment facilitated the process of re-inserting one's body into the flow of one's experience in two opposite, but complementary ways: (1) it invited this person to move automatically without taking into account his body; (2) it invited him to take an instrumental or rational view on his body. Both processes fostered his trust in the device, and ultimately in his body. IMPLICATIONS FOR REHABILITATION: Providing (more) technological explanation of the technological device (i.e. the virtual environment), may facilitate a rehabilitation process. Providing (more) explicit technological feedback, during training sessions in a virtual environment, may facilitate a rehabilitation process.

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Characteristics of Successful Technological Interventions in Mental Resilience Training.

J Med Syst. 2014 Sep;38(9):113

Authors: Vakili V, Brinkman WP, Morina N, Neerincx MA

Abstract. In the last two decades, several effective virtual reality-based interventions for anxiety disorders have been developed. Virtual reality interventions can also be used to build resilience to psychopathology for populations at risk of exposure to traumatic experiences and developing mental disorders as a result, such as for people working in vulnerable professions. Despite the interest among mental health professionals and researchers in applying new technology-supported interventions for pre-trauma mental resilience training, there is a lack of recommendations about what constitutes potentially effective technology-supported resilience training. This article analyses the role of technology in the field of stress-resilience training. It presents lessons learned from technology developers currently working in the area, and it identifies some key clinical requirements for the supported resilience interventions. Two processes made up this research: 1) developers of technology-assisted resilience programs were interviewed regarding human-computer interaction and system development; 2) discussions with clinicians were prompted using technology-centered concept storyboards to elicit feedback, and to refine, validate and extend the initial concepts. A qualitative analysis of the interviews produced a set of development guidelines that engineers should follow and a list of intervention requirements that the technology should fulfill. These recommendations can help bridge the gap between engineers and clinicians when generating novel resilience interventions for people in vulnerable professions.

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Irving Berlin eat your heart out. There’s no business like the healthcare business or so it seems from a recently published info-graphic in the Wall Street Journal. Where are the jobs in America? You guessed it, healthcare. But is that a healthy thing...(read more)
Source: HealthBlog

Items available. (2)Not so long ago, CCR and CCD were both common terms used in health IT. In fact, both CCR and CCD were compliant formats for sending patient summary data in the 2011 Edition of EHR certification. But since CCR was left out of the 2014 Edition of EHR certification as a valid way to send summary of care documents, the term has started to fade away.

As a refresher, CCR stands for Continuity of Care Record and it was an electronic document utilized for transferring patients. It started out as a paper document, and had a long history of providing appropriate clinical data so that the patient’s care could continue. CCR was an ASTM standard.

At the same time, HL7 developed their CDA standard that could apply to all types of documents utilized in a healthcare setting. To make a long story short, the content from a CCR was merged into a CDA format and the newly created document was called the Continuity of Care document, or CCD.

Even though CCD was meant to be the harmonization of CCR and CDA, CCR still stuck around for a while and was included in the original rules for Meaningful Use Stage 1. As a vendor testing for the 2011 Edition criteria related to Meaningful Use Stage 1, Corepoint Health had the choice in our test procedures to utilize a CCD or CCR to test for §170.306 (d)(1) Electronic Copy of Health Information. As an integration application, we also had OEM customers who utilized our application to test for this criteria. We would always ask, “Did you chose CCR or CCD for your testing?” Everyone would answer CCR. Why? Their response: “It’s just simpler.”

But now with Meaningful Use Stage 2 and the 2014 Edition of EHR certification there is no choice. Consolidated CDA, which includes CCD as one of its document types, is the standard of choice. To gauge the progress of using Consolidated CDA so far, JAMIA recently published a study. The study found that many EHR systems do not exchange data correctly using Consolidated CDA.

The study sampled 107 healthcare organizations using 21 EHR systems and found 615 errors and data expression variation across 11 key areas. The errors included missing data, incorrect coding terminology, and errors within the XML. The researches commented that “any expectation that Consolidate CDA documents could provide complete and consistently structured patient data is premature.”

With such apparent struggles for vendors and implementers to get the standard correct, you may be wondering, “Why did healthcare IT go the more complex route?” It was already apparent from the 2011 Edition EHR testing that vendors preferred the simplicity of CCR when given the choice. So why then does Consolidated CDA make sense for the path moving forward?

Consolidated CDA is made up of nine document types – including CCD, Discharge Summary, Diagnostic Imaging Report, Consultation Note, and others. And while the schema for CDA is much more complex that CCR, it can be applied to many more use cases. So while the bar is set high to get the summary of care document truly interoperable for Meaningful Use Stage 2, the bar should be much lower to allow for other types of Consolidated CDA documents to be added once interoperability is achieved for summary of care.

Did healthcare IT chose the wrong path by not choosing CCR? It certainly seems so at this point. But one must also step back and ask where the industry should be three to five years from now. Do we want Diagnostic Imaging Reports to be commonly exchanged as electronic documents? How about Consultation Notes?

If we are at the end of the road and in the future we only ever want to exchange documents for transition of care, then I say we definitely should have chosen CCR. It’s just easier. But if we have a longer term vision of interoperability that includes more document types than just for transition of care, then the price paid now to get Consolidated CDA working should speed up the progress of the utilization of all the document types included in the Consolidated CDA family.

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When I was speaking at the gMed user conference, I learned about many of the users who participated on a GI focused online forum for gMed users. Essentially it’s an independent user group for gMed EHR users. Although, with so many GI doctors in one place, you can be sure there are all sorts of focused discussions that would be of interest to gastroenterology doctors.

Of course, there are a lot of other online forums that are similar to the GI forum. For example, Amazing Charts has a really active user forum. The open source EHR, OpenEMR also has a forum. I’m sure there are a lot more. I’d love to hear about other EHR forums you know about in the comments.

Many people probably don’t know that I built up much of my EMR knowledge participating in the now defunct EMR Update. It was a fantastic way for me to learn and share my knowledge. I’m sure that those who participate in the various EMR forums above get the same benefit. Although, it’s probably even more valuable since the forums above are all on the same EHR software.

I can’t tell you how valuable it is for a clinic to be able to turn to other users when they run into trouble. One of the best ways to optimize your EHR is to interact and exchange ideas with other end users. That’s why I’ve started creating a list of EHR user conferences as well. However, for those who can’t take the time off to go to a user conference, an online discussion forum is a great alternative. I’m surprised that more EHR vendors don’t create these types of forums.

European CommissionThe specific challenge of the actions envisaged under this call could cover any aspect of the Specific Programme for Space (Horizon 2020 Framework programme and Specific programme). The SME instrument consists of three separate phases and a coaching and mentoring service for beneficiaries. Participants can apply to phase 1 with a view to applying to phase 2 at a later date, or directly to phase 2.
This appeared a few days ago:Campaign for single eHealth record, says YoungBy Natasha Egan on July 23, 2014 in In-depth, Industry, Technology AUDIO: Aged Care Industry Information Technology Council representative Rod Young has called on the sector to campaign for a single eHealth and aged care record at the council’s annual technology conference currently underway in Hobart.Mr Young, Associate Professor Kate Swanton from Feros Care and Dr George Margelis took part in a panel discussion on the government’s eHealth record at the Information Technology in Aged Care (ITAC) conference on Tuesday.All three speakers agreed that, when it began doing assessments in July 2015, the My Aged Care record would add another unnecessary layer to an already complex system.After the panel discussion, AAA’s Natasha Egan spoke with Mr Young, a former peak body CEO and now an advocacy and policy consultant with service provider IRT, about the problems an additional record posed for the sector:Here is the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

July 29,2014


The topic of companion diagnostics has been of continuing interest for me. I have posted a number of notes about this type of lab test (see, for example: More Details About Roche's Companion Diagnostics StrategyA Closer Look at Companion Diagnostics StrategiesConsideration of a Broader Definition for "Companion Diagnostics"Some Interesting Insights into Companion DiagnosticsCompanion Diagnostics Gains Wider Acceptance in FDA Despite Challenges). Now comes news of a new collaboration between AstraZeneca and Roche on a diagnostic test to be used as a companion for AZ9291, an investigational compound (see: AstraZeneca, Roche Collaborate on Companion Diagnostic Test). Below is an excerpt from the article:

AstraZeneca announced it has entered into collaboration with Roche to develop a plasma-based companion diagnostic test to support AZD9291, AstraZeneca’s investigational compound in clinical development for non-small-cell lung cancer (NSCLC). The companion diagnostic test is designed to identify epidermal growth factor receptor (EGFR) mutations in both tumor tissue and plasma derived from patients with NSCLC, and to optimize the clinical development of AZD9291 for patients who are resistant to first-generation EGFR tyrosine kinase inhibitors (TKI). Currently, patients who have been treated with EGFR-TKIs in whom the disease has progressed have to undergo a repeat biopsy to assess whether they have a specific mutation, T790M. Diagnostic tests based on circulating DNA (ctDNA) in plasma samples provide an alternative method of identifying the T790M mutation....“Currently, late-stage lung cancer patients have to undergo surgery to collect tissue from a tumor so it can be sent for molecular testing,” said Paul Brown, head of Roche Molecular Diagnostics (RMD). “In some cases, collecting enough tissue for testing is not possible. This collaboration will enable molecular testing through plasma specimens and provide the information needed to inform treatment decisions without the complications of surgery, consequently increasing the level of care clinicians can give to the patient.” NSCLC represents approximately 80 to 85% of all lung cancers. Unfortunately, at the time of diagnosis approximately 70% of NSCLC patients have developed advanced or metastatic disease not amenable to surgical resection. 

To summarize, AstraZeneca is working with Roche on a companion diagnostic to identify epidermal growth factor receptor (EGFR) mutations in both tumor DNA as well as in DNA circulating in plasma. The source of the latter is circulating tumor cells (ctDNA). Analysis of plasma ctDNA to detect tumor recurrence avoids the need to biopsy tumor tissue and thus the complications of additional surgery. This article illustrates the dual use of companion diagnostics. First of all, the test can be used to determine whether a patient is a candidate for a particular drug therapy -- compound AZ9291 in this case. The fact that the drug does not yet have a proprietary name is evidence of the very early stage at which the companion diagnostic is being developed. Secondly, the diagnostic test can also be used to identify circulating tumor DNA in the plasma.

NSCLC, a confusing term, is the most common type of lung cancer. Unfortunately and as noted above, some 70% of NSCLC patients have advanced disease at the time of diagnosis that is not amenable to surgical resection. The term NSCLC encompasses the following three histologic types of neoplasm (see: Lung cancer - non-small cell): 

  • Adenocarcinomas that are often found in an outer area of the lung.
  • Squamous cell carcinomas that is usually found in the center of the lung next to a bronchus.
  • Large cell carcinomas that can occur in any part of the lung. They tend to grow and spread faster than the other two types.

And the winner is... Sabine Petry and co-workers, Petry Lab, Princeton Department of Molecular Biology.

Description: Microtubules are hollow filaments that serve as the skeleton of the cell. They were thought to grow linearly, but this movie shows that they can branch: microtubules (red with growing tips in green) grow off the wall of existing microtubules. In addition, microtubules are moved along the glass surface by molecular motors. Microtubule branching amplifies the microtubules while preserving their polarity and explains how microtubules can cause the mitotic spindle of a dividing cell to reliably segregate chromosomes (Petry et al., Cell 2013).

Scale: A microtubule has a diameter of 25 nanometer and is the largest cytosekeletal filament in the cell.

More on the Princeton University Art of Science competition: http://artofsci.princeton.edu/

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Via Textually.org

Screen Shot 2014-07-19 at 9.20.00 AM.png

Sidewalk collisions involving pedestrians engrossed in their electronic devices have become an irritating (and sometimes dangerous) fact of city life. To prevent them, what about just creating a “no cellphones” lane on the sidewalk? Would people follow the signs? That’s what a TV crew decided to find out on a Washington, D.C., street Thursday, as part of a behavioral science experiment for a new National Geographic TV series. [via Quartz]

As expected, some pedestrians ignored the chalk markings designating a no-cellphones lane and a lane that warned pedestrians to walk “at your own risk.” Others didn’t even see them because they were too busy staring at their phones. But others stopped, took pictures and posted them—from their phones, of course.
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Real-time functional MRI neurofeedback: a tool for psychiatry.

Curr Opin Psychiatry. 2014 Jul 14;

Authors: Kim S, Birbaumer N

Abstract. PURPOSE OF REVIEW: The aim of this review is to provide a critical overview of recent research in the field of neuroscientific and clinical application of real-time functional MRI neurofeedback (rtfMRI-nf).
RECENT FINDINGS: RtfMRI-nf allows self-regulating activity in circumscribed brain areas and brain systems. Furthermore, the learned regulation of brain activity has an influence on specific behaviors organized by the regulated brain regions. Patients with mental disorders show abnormal activity in certain regions, and simultaneous control of these regions using rtfMRI-nf may affect the symptoms of related behavioral disorders. SUMMARY: The promising results in clinical application indicate that rtfMRI-nf and other metabolic neurofeedback, such as near-infrared spectroscopy, might become a potential therapeutic tool. Further research is still required to examine whether rtfMRI-nf is a useful tool for psychiatry because there is still lack of knowledge about the neural function of certain brain systems and about neuronal markers for specific mental illnesses.

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As much as I dislike being a patient, I have to admit it’s a good experience for a health care professional to go through. To be on the receiving end of the healthcare system not only helps me develop compassion for patients and families, but it also gives me a clearer vision of what we’re doing right and what we need to work on when delivering care. And it’s also given me some insight into patient satisfaction vs. patient-centered care.

A month or so ago I wrote a post on patient satisfaction scores and how health care providers are focusing on improving those scores, sometimes to the dismay of clinicians. I now have the opportunity to experience the health care system as a patient and be a satisfied or a dissatisfied consumer (or somewhere in between).

Recently, I paid visit to a dietitian and diabetes nurse educator because of a diagnosis of gestational diabetes. I was told to call the hospital’s central scheduling department to make the appointments. When I did, I was given two different dates two weeks apart, the first with the diabetes educator and the second two weeks later with the dietitian. I was given a long explanation about how the hospital was under construction and the bridge to the main hospital was closed, which is why I needed to enter through the medical office building entrance. It was also advised that I come 45 minutes early.

Then over the next few days I received follow-up calls from the scheduling department regarding the two appointments. When I returned the calls, a different employee took my call and wasn’t sure what the follow-up was regarding. I had assumed it was just to verify the times two weeks apart.

When I showed up for my appointment I followed the instructions then realized I was never given a suite number for the visit. I did my best to guess which one it was, but they were all closed. Why did I need to be there 45 minutes in advance? Perhaps I needed to stop in main hospital’s registration department first, after all they did mention something about the bridge being closed. So I got in my car and drove over to registration where I sat for 15 minutes before they called me over to discover that I had been in the right spot in the first place and I should go back. As I readied to get back into my car I asked what the suite number was. The registration employee had no idea and had to call the educator’s office to find out.

Once I settled in for my appointment, the educator asked about the instructions I was given and I told her I wasn’t given a suite number and was told to come 45 minutes early. She was none too pleased to hear that. Then she informed me that my appointment with the dietitian was immediately following my appointment with her. So that’s what the scheduling department was calling about! I told her that was great but I had no idea. She also told me that the employees in central scheduling could not see the same scheduling screen as the folks in the diabetes center and often did not know that earlier appointments were available.

Was this a satisfying experience? Not really. But the clinical care from the educator and dietitian was very good. They really listened when I explained how I felt about being there (annoyed at the diagnosis) and worked to try to come up with an eating and glucose testing schedule that fit my night shift job. After seeing them I knew what to do, when to do it, and who to call if something was off. With their focus on my needs, they were providing patient-centered care.

If asked if I was satisfied with my experience how would I respond? The scheduling process could have used some work but the clinical care was quite good.

This experience got me thinking about patient satisfaction and patient-centered care and how there is a distinct difference between the two. The writers of a July 2012 JAMA article Patient Satisfaction and Patient-Centered Care Necessary but Not Equal share my opinion.

Patient-centered care, as defined by the Institute of Medicine in its 2001 report Crossing the Quality Chasm, is defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions,” whereas the JAMA authors explain, patient satisfaction is based on consumer marketing and measures the quality of the service against the consumer’s expectations.

As pointed out in the 2011 article The Values and Value of Patient-Centered Care in the Annals of Family Medicine, what some hospitals have been calling patient-centered care is “superficial and unconvincing.” Things like greeters and hotel-like decor “might enhance the patient’s experience, they do not necessarily achieve the goals of patient-centered care.”

When looking at my experience, the scheduling department did not meet my expectations — to give the appropriate information like suite number and arrival time. Yes, I was not satisfied with the scheduling experience but not getting the correct information did not harm me in any way. However, if the diabetes center had not taken my unique situation into account and given me a health regime that fit my night shift schedule, then my health outcomes could have been compromised. Had I gotten the correct scheduling information but not appropriate clinical care, in theory I could have been happy but not as healthy.

In an opinion piece in Circulation: Cardiovascular Quality and Outcomes, the author writes that satisfied patients can still have poor clinical results, though more research on the correlation between patient-satisfaction, patient-centered care and patient outcomes needs to be done.

I agree and would also argue that when health care providers focus on patient-centered — because patients feel heard and valued with this type of care — high satisfaction scores will follow. Plus, there will be better patient outcomes when patients are participating in their care. If you had to pick one area to focus on, patient satisfaction vs. patient-centered care, I’d focus on patient-centered care.

Two resources to help providers achieve patient-centered care are The Journal of General Internal Medicine‘s A 2020 Vision of Patient-Centered Primary Care and Plantree’s Patient-Centered Care Improvement Guide. Both help providers assess their implementation of patient-centered care and give pointers on how to improve care delivery.

Perhaps it’s because I have always worked in the clinical setting that I believe good clinical care can trump, or at least balance, parts of an experience that are less satisfying. Healthy patients equal happy patients and I feel they, like me, would be more willing to compartmentalize different aspects of the care experience. Because they are treated like individuals and listened to by their clinicians, they’ll be less likely to give an overall poor satisfaction score if something, like scheduling, goes amiss. And let’s not forget that despite how health care has changed over the years, good health outcomes are really what it is all about.

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We’re just now starting down the road of the EHR replacement cycle. Meaningful use has driven many to adopt an EHR too quickly and now the buyer’s remorse is setting in and we’re going to see a wave of EHR replacements. Some organizations are going to wait until meaningful use runs it course, but many won’t even be able to wait.

With this prediction in mind, I was interested by this Allscripts whitepaper: Key Hidden Reasons Your EHR Is Not Sustainable and What To Do About It. I always learn a lot about a company when I read whitepapers like this one. It says a lot about the way the company thinks and where they’re taking their company.

For example, in the whitepaper, Allscripts provides a list of questions to consider when looking to replace your EHR:

  • How do you DEPLOY the right core IT systems to succeed with value-based care?
  • How do you CONNECT to coordinate care with key stakeholders and manage your population?
  • How do you better ENGAGE patients in their own health?
  • How do you analyze mountains of raw data to ADVANCE patient and financial outcomes?
  • How do you get everyone within your own organization to FOLLOW THE ROADMAP to EHR success?

You can see that these questions share a certain view of where healthcare IT and EHR is headed. Imagine how this criteria would compare with the criteria for EHR selection even five years ago. Although, I wonder how many doctors really share this type of approach to EHR selection. Do doctors really want their EHR to handle the above list? Should they be worrying about the above items?

I don’t doubt that doctors are going to be more involved in population health and they’re going to need to engage patients more. However, this list does seem to lack some of the practical realities that doctors still need from their EHR. In fact, as I write this, I wonder if it’s still too early to know what a next generation EHR will need to include. Of course, that won’t stop frustrated EHR users from replacing their EHR just the same.

Well, folks, it’s that time again: The Pan Mass Challenge is coming up this weekend -- the first weekend of August, as always -- and this will be my eleventh year as part of the PMC. Every year, riders along...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg
BridgeHead SoftwareBridgeHead Software, the Healthcare Data Management specialist, and Alstor, the storage solutions provider, today announce a new partnership. This agreement allows Alstor to extend its existing portfolio to include BridgeHead Software's Healthcare Data Management (HDM) Solution, offering Polish hospitals a unique software environment to store, protect and share clinical and administrative information, both on-premise, in the cloud or a hybrid configuration.
This appeared a few days ago:Minister puts future of $422m SA eHealth system in doubtBy Paris Cowan on Jul 23, 2014 6:30 AM (4 hours ago) EPAS still on hold.South Australian Health Minister Jack Snelling has refused to commit to the continuation of the state’s $422 million electronic patient administration system (EPAS) rollout, which is currently on hold as the government works through funding and performance issues.“We are having a look at it at the moment,” Snelling said, when challenged by opposition MP Duncan McFetridge to guarantee the rollout during an estimates hearing late last week.“We have obviously put a pause on the rollout, which has partly been driven as a result of the federal cuts."The SA Government paused a cluster of capital works programs within the health portfolio in response to a fall in revenue from the Commonwealth Budget.But the halt on EPAS work has also come as the result of user headaches plaguing the implementation.“It was sensible also, for the moment,...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

July 28,2014


I believe that there is inadequate strategic planning taking place in pathology and by pathologists. It's true that many of the individual pathology societies support some strategic planning activities but there are few published reports articles addressing the challenges facing our specialty. Here's what I consider the four of the most important challenges facing the field consideration from a strategic perspective: (1) cancer oncology; (2) digital pathology; (3) the future of the LIS; (4) increased lab complexity with reduced lab budgets. 

By way of contrast, radiologists has been addressing strategic planning in their field head-on for many years. For example, the International Society of Strategic Studies in Radiology (ISSSR) held its ninth biennial meeting in August 2011. Here is the citation for the published proceedings of that meeting: Eur Radiol (2012) 22:2283-2294. This article is a revealing compendium about what the future holds for radiology. A number of topics are addressed in the proceedings including molecular imaging, diagnostic algorithms, information technology in radiology, integrated diagnostics, and health information exchanges. Here's a passage from the article describing population imaging:

Population imaging employs computational radiology techniques such as unstructured and structured data mining, image segmentation, and statistical modeling to map and summarise imaging features from large image databases and thus extract meaningful imaging biomarkers. The biomarkers may be anatomic structures, disease manifestations, tumour characteristics, or haemodynamic abnormalities. The summation of one or more imaging features, or biomarkers, from a global data set can be considered a phenotypic “population image” representing a particular disease or health state. In clinical care or clinical trials, population images may be used as a reference to classify individuals or patient groups into diagnostic categories. Radiologists can play a key leadership role in providing the needed intuition to productively integrate the computational information from population images with personal medical information....These imaging biomarkers may facilitate prediction of future disease onset, the development and implementation of preventive measures, and even the development of pre-clinical diagnostics....Furthermore, because of the statistical power provided by large sample sizes, population studies using global databases could potentially replace individual prospective studies as a means of validating new biomarkers, saving both time and money.

Here's a more succinct definition of population imaging (Population Imaging):

The ultimate aim of the European Population Imaging Infrastructure is to help the development and implementation of strategies to prevent or effectively treat disease. It supports imaging in large, prospective epidemiological studies on the population level. Image specific markers of pre-symptomatic diseases can be used to investigate causes of pathological alterations and for the early identification of people at risk.

I certainly applaud the strategic planning efforts of our colleagues in radiology and this focus on population imaging effort has tremendous merit. However, the apparent absence of clinical and anatomic pathology data  in this project is a significant problem.


The following is a guest blog post by Trevor James.

If you work in the health/dental/medical space, you already know that HIPAA violations are a serious matter. Fines today for not complying with HIPAA laws and regulations are a minimum of $100-$50,000 per violation or record and a maximum of $1.5 million per year for violations of the same provision. Some violations also carry criminal charges with them, resulting in jail time for the violators.

Many dental offices are breaching HIPAA laws without realizing it or have employees doing so without their knowledge.

If you’re a dentist, office manager, or someone who’s been tasked with ensuring HIPAA security within your group, here are the 10 most common ways dental offices are breaching HIPAA regulations so your practice doesn’t make the same mistakes as others.

1. Devices with patient information being stolen

This is a common HIPAA violation for dental offices. It’s important to ensure the devices your dental office uses, like USB flash drives, mobile devices and laptops, are carefully handled and securely stored to prevent them and the patient information on them from being stolen.

2. Losing a device with patient information

Along the same lines as above, it’s also easy (and common) for an employee to lose those kinds of devices. USB flash drives and mobile devices are smaller items, so it’s easy to misplace them. When that happens, it’s easy for sensitive patient information to end up in the wrong hands.

Train your employees on the importance of properly handling these devices and set up some sort of tracking device, like downloading the Find My iPhone app or Where’s My Droid, to help you locate a device if it ends up lost.

3. Improperly disposing of papers and devices with patient information

When it comes time to get rid of papers or devices containing dental records or billing information, be sure you properly dispose of them. Crumpling paper in a ball and throwing it in the trash isn’t the correct way to do things nor is shutting down a device and then tossing it in the garbage. Use a paper shredder and wipe your devices clean of all information before disposing of them.

4. Not restricting access to patient information

Unauthorized access to a patient’s dental information will get you in serious trouble with HIPAA. Patients trust your office with this personal information, so be smart when handling such information so other patients, employees and relatives who aren’t allowed access don’t come across it.

A dental practice breached HIPAA in a case relating to this when they put a red sticker reading “AIDS” on the outside cover of patient folders and those not needing to know said information were able to read it while employees handled the folders. Don’t make simple, costly mistakes like they did.

5. Hacking/IT incidences

Most patient dental information now is stored on computers, laptops, mobile devices, and in the cloud. Today’s technology allows dental practices to more easily communicate, and look up and share patient information or their status on these devices.

The downfall of this technology is the people who are just as smart or smarter than your technology and hack into your devices or systems to get their hands on patient information. Make sure every device has some type of passcode or authentication to get on, install encryptions and enable personal firewalls and security software.

6. Sending sensitive patient information over email

While it’s not a violation to send these kinds of emails, it is a violation if the email is intercepted and/or read by someone without authorized access. Use encryptions and double check that whomever you’re sending the email to is supposed to be receiving the email.

7. Leaving too much patient information over a phone message

A patient may give you the A-Okay to call them, but be sure you don’t leave a message disclosing too much of their information. A friend or family member could check your patient’s message and hear things they shouldn’t, making said patient upset, or equally as bad, you could call the wrong number and say more than you should, which would probably make your patient even more upset with you. Your safest bet when calling a patient and they don’t answer is to leave a message for them to call you back.

8. Not having a “Right to Revoke” clause

When your dental office creates its HIPAA forms, you have to give your patients the right to revoke the permissions they’ve given to disclose their private dental information to certain parties. Not providing this information means your HIPAA forms are invalid and releasing subsequent information to another party puts you in breach of HIPAA.

9. Employees sharing stories about patient cases

People talk. It’s a simple fact. Employees talk with one another and they also talk to patients every workday. Remind them, though, that discussing a patient’s information to an employee lacking authorized access or to other patients is unprofessional and puts your whole practice at risk of being fined by HIPAA.

10. Employees snooping through files

It might seem shocking — or maybe not to some — but employees have been caught snooping through patient and co-worker files before. They do this to find out information for themselves but also because relatives or friends ask them to find things out about a certain person. Snooping is wrong and unprofessional on all levels.

Make sure your employees are clear on this and that they understand how bad the consequences can be for them and your office for doing so.

HIPAA violations in dental offices are all too common. Now that you know the top 10 ways dental offices are breaching HIPAA, you can take every precaution necessary to prevent your practice from violating any HIPAA laws and regulations.

About The Author

Trevor James is the marketing manager for Dentrix Ascend, a cloud based dental practice management software and Viive, a dental practice software for Mac’s.

Jayex, recognised as a leading provider of healthcare self-service and patient flow management solutions, is enabling Imperial College Healthcare NHS Trust to fast-track patient check-ins seamlessly from the entrance to the waiting area, in one of the largest deployments of its kind to date across Europe. This is anticipated to streamline the trust's one million annual outpatient encounters, whilst improving data quality and efficiency.
Here are a few I have come across the last week or so.Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General CommentSome interesting items this week - especially the apparent problems with the South Australian e-Health roll out - that until recently was seen as going pretty well. Given there has not been a change of Government in SA, who have driven the project for a good number of years, it seems there is really a problem. After the problems in Qld, Victoria and WA this is all getting a bit frustrating! -----http://www.itnews.com.au/News/390186,minister-puts-future-of-422m-sa-ehealth-system-in-doubt.aspxMinister puts future of $422m SA eHealth system in doubtBy Paris Cowan on Jul 23, 2014 6:30 AM EPAS still on hold.South Australian Health Minister Jack Snelling has refused to commit to the continuation of the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

July 27,2014


I agree with Wen that the EMR and claims data needs to be cleaned up. I think it gives the wrong message to say it’s not meaningful though. Once it’s cleaned up, it has a lot of value.

How many of you have applied for a job because you saw it posted on Twitter? I’m really interested in this since I do a lot of health IT job posts on Twitter. We see quite a bit of traffic from Twitter to our healthcare IT job board, but I haven’t added a good way to track who signs up and applies for jobs. That’s next.

I love how academic Practice Fusion tries to make the discussion. I thought I made the discussion of EMR vs EHR much simpler.

This appeared last week.Andrew Knight: e-Health revolutionAndrew KnightMonday, 21 July, 2014THE benefits of having an effective electronic health record seem obvious. Rapid sharing of information, reduction of duplication and greater ownership by patients of their health information offer hope of reduced harm and savings in time and money.The review of the personally controlled electronic health record (PCEHR) commissioned late last year by the federal government certainly thinks so.The reviewers point to modelling which suggests that e-health changes could lead to savings of $7 billion a year by 2020. The modelling estimates implementing e-health would avoid 5000 deaths, two million outpatient visits, 390 000 hospital admissions and 10 million laboratory and imaging tests by 2020.    The overwhelming majority of those making submissions to the review were also supportive. According to the review, more than 1.2 million Australians have demonstrated support by registering...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

July 26,2014

Here are the results of the poll.Do You Think Continuing Work On The PCEHR Can Lead To A System That Will Improve The Quality, Safety and Efficiency Of Healthcare? I.E. Is The PCEHR Fixable?For Sure 20% (14) Maybe 16% (11) Neutral 6% (4) Probably Not 17% (12) No Way 40% (28) I Have No Idea 1% (1) Total votes: 70 A very good response and the view 57% to 36% that the PCEHR is not really fixable with very few undecided. Time will tell who is right! Again, many thanks to all those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

July 25,2014


One of the major goals of Big Pharma is to enlarge its customer base, which is to say, sell more product. One way to accomplish this is through the medicalization of "conditions" that previously have not been viewed as diseases. One example of such a condition is obesity. This medicalization process has also been referred to as "disease mongering" (see: Disease Mongering (i.e., Medicalization) by Pharmaceutical CompaniesMedical Device Mongering, a Variant of Disease Mongering). The reason that Big Pharma spends huge amount of money each year on direct-to-consumer (DTC) advertisements on TV is to circumvent physicians by creating demand for prescription drugs among consumers (see: Effectiveness of "Direct-to-Consumer" Drug Advertisements). Although consumers can't write prescriptions, they can certainly request a particular drug from their physician.

Given all of this, it should not be surprising that the pharmaceutical industry is  teaming up with Silicon Valley companies to develop wearable IT devices to monitor health. The details of a recent Google/Novartis deal were discussed in a recent article in the Financial Times (see: Big pharma teams up with big data). Below is an excerpt from it:

Big pharma and Silicon Valley have been circling one another for some time, looking for ways in which they might harness the power of data technology to medical ends. Now a fusion of West Coast entrepreneurship and lab-coated medical expertise has spawned its first big publicly announced transaction. Google has struck a deal with Novartis to develop a “smart” contact lens designed to help diabetics track their blood sugar levels. The lens works by analysing the level of glucose in a wearer’s tear fluid and communicating the data to a mobile device. It replaces the need for diabetics to test their own blood sugar several times a day....But this is only one of the reasons to applaud the marriage of pharma and big data, and the emergence of such “wearable” medical devices. The increasing incidence of chronic diseases and an ageing population has created the need for real-time health monitoring. At a time of stretched healthcare budgets, having a device that tracks the state of the wearer’s health can help to give physicians better early intelligence of problems, reducing the need for costly interventions and long hospital stays later on. Monitoring is, moreover, only part of the story. Wearable technology may also have a role to play in treating conditions. For instance, Novartis is also looking at using Google’s technology to produce an “autofocusing lens”....Another area of investigation is into so-called “electroceuticals”. These are implants that use electronic impulses to affect and modify the functions of the body. 

I have no problem with wearable devices for monitoring health status. I think that this is both inevitable and useful for increasing health awareness among the general population if not to improve health. I am also enthusiastic about the notion of having healthcare consumers take more ownership of their own health status. Early autodiagnosis and ongoing health monitoring is certainly one way to reduce the cost of healthcare by avoiding the expense of nagging chronic diseases. Why then would I be concerned about pharmaceutical companies getting involved in the development of such devices? My greatest fear is that the companies will "fudge" these devices such that the diagnosis of various diseases and the need for treatment will be overstated. This will be an extension of the medicalization discussed in the first paragraph. One example of such chicanery was a rigged depression survey that Eli Lilly posted on the web. The company manufactures the anti-depressant Cymbalta. Regardless of how one answered the survey, the conclusion was that the subject may be depressed (see: Rigged Depression Survey on the Web Steers Readers to Lilly's Cymbalta). 


I’ll admit that I’m a sucker for infographics. I usually post the various EHR infographics I find on EMR Thoughts, but this one seemed more appropriate to post on EMR and HIPAA. You can find all of the various EHR and Health IT infographics I’ve posted on this Healthcare IT Infographic pinterest board as well.

Thanks to Coalfire for putting together this HIPAA Security Risk Analysis Myths infographic.

Update: David Harlow offered this interesting note that might be helpful to some “The infographic suggests that only covered entities need to undergo a security risk assessment. In the EHR context that makes sense, since them with EHRs are CEs, but of course Business Associates need to do this too.”

HIPAA Risk Assessment Infographic

European Telemedicine Conference7 - 8 October 2014, Rome, Italy.
The European Telemedicine Conference (ETC) 2014 will combine the efforts of several leading European Healthcare Organisations into one powerful event. The conference will collaborate with prominent healthcare delivery organisations, governmental leaders, clinicians, researchers and university faculties to address and discuss the following:

July 24,2014

As you might expect considering my profession and where I work, clinicians frequently ask me, “What kind of computer is best for clinicians?” My answer typically goes something like this. “Well, it depends. If I’m out to dinner with my wife and on call...(read more)
Source: HealthBlog
PhilipsRoyal Philips (NYSE: PHG; AEX: PHIA) today announced that it has signed an agreement to acquire Unisensor, an innovator in the field of optical analysis of fluids for diagnostic applications in health care, as well as other industries. The Unisensor technology and team will strengthen Philips' innovation capabilities in the field of patient sample analysis such as blood testing for applications in oncology therapy monitoring.

This is a new tamper proof drug which means if it is crushed it looses it affect, but of course imagepeople can still swallow the pills.  Purdue will have to conducted follow up studies on rates of abuse, addiction and death as that’s a standard anymore for any Opioid drugs.  BD

Washington • The Food and Drug Administration has approved a new combination pain pill from the maker of OxyContin that is designed to discourage abuse by painkiller addicts.

Purdue Pharma’s new drug Targiniq ER is an extended release tablet that combines oxycodone — the active ingredient in OxyContin — with the drug naloxone. FDA regulators approved the drug for daily, round-the-clock pain that does not respond to other medications.

Stamford, Connecticut-based Purdue has often been cited by public health advocates as a key contributor to the overprescribing of opioids. In 2007, Purdue Pharma and three of its executives paid $634 million and pleaded guilty to charges of misleading the public about the safety and addictiveness of OxyContin.



Is this a great story or what?  Listen to the video and read below about his past, pretty grizzly so he’s off his rocker to begin with.  He earned his money the old fashioned way, he inherited it.  He was recognized as a regular patron at the store.   BD 


A New York City real estate heir acquitted of his neighbor's murder a decade ago is back in trouble, this time for a bizarre imageoutburst in which police say he urinated on a rack of candy at a Texas drug store.

Police say multimillionaire Robert Durst unzipped his pants in a Houston CVS, exposed himself and then urinated on a cash register and candy before walking away from the store just after noon Sunday, Houston NBC affiliate KPRC reported.

He had left the scene by the time police arrived, but on surveillance video he did not appear to have been agitated or argumentative before the incident, police said.

Durst had been arrested in 2001, jumped bond, was found in Pennsylvania trying to steal a sandwich and a Band-Aid from a grocery store and eventually faced trial in the murder. He claimed he had shot Morris Black in self-defense during a struggle over a gun, according to the Houston Chronicle.


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