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Eastern Health has rolled out a new trial across its Box Hill Hospital to help patients better manage their medication after they leave hospital. DC MedsRec, the community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, aims to reduce the risk of harm from dangerous drug interactions. The trial, conducted in collaboration with the Australian Digital Health Agency (ADHA) and Monash University, will enable eligible patients to meet with trained community pharmacists, who will look at their hospital discharge summary via My Health Record (MHR), along with a range of other medication information on their Electronic Medical Records (EMRs). The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from the hospital are followed up. The pharmacist will also offer to dispose of any discontinued medications and prescriptions for the patient, with their consent. The move follows Eastern Health’s successful EMR implementation at Box Hill Hospital In October 2017, in partnership with Cerner, as part of its Great Digital Information Strategy 2015-2020. ADHA CEO Tim Kelsey said the service was part of a $8.5 million program that trials innovative and new approaches to post-hospital support, palliative care and the management of chronic health conditions using digital technology. “Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said. “The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in hospital after taking a bad combination of medicines.” Monash University Project Lead Greg Duncan said the trial was initiated as a result of poor medication management during or immediately after a hospital stay, which becomes a risk factor in 28 per cent of potentially avoidable hospital readmissions within 30 days. “We know medication errors often occur when patients leave hospital and can mean patients end up being readmitted – so we will assess the impact of this new service on 30-day unplanned readmission rates to hospital,” he said. [Read more: Inability to meet patient engagement demand is “hobbling” Australian healthcare providers: study | NSW’s hospitals enroute to state-wide Electronic Record for Intensive Care (eRIC) implementation] Eastern Health Chief Executive Adjunct Professor David Plunkett said the trial positions the organisation to “provide both excellent clinical care and research”, with real-world benefits. “Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5000 patients potentially involved,” he said. The success of the service will be evaluated after 12 months, with Kelsey adding that the results could potentially shape future projects, helping patients throughout Australia better manage their medicines.

The industry has some unique challenges to tackle and moving to the cloud often leads to breaches.

The pharmaceutical industry’s biggest barrier? Data, of course.

Despite its clear potential to improve access to high-quality care in underserved communities, telehealth is underutilized by safety-net providers due to a range of barriers, according to a new report from the RAND Corporation. The analysis, based on interviews with Medicaid officials from seven states and representatives from 19 Federally Qualified Health Centers in those states, points to insufficient reimbursement as a leading culprit for this lag, in addition to other logistical, policy and operational barriers. WHY IT MATTERS Telehealth can help rural, low-income and vulnerable populations better access health care -- and analyses have shown use of this technology, particularly live video telehealth, is growing among FQHCs. In some cases, telehealth is the only way to bring specialists into remote places. But uptake, maintenance and expansion of telehealth services have been spotty at best. The RAND report, sponsored by the Department of Health and Human Services, seeks to find out why. Interviews with Medicaid and FQHC stakeholders revealed a lack of clarity around state telehealth policies and insufficient reimbursement as top barriers to adoption. Other limiting factors included: infrastructure issues (e.g., insufficient broadband), technology costs, telehealth as a cost center, billing challenges, lack of buy-in among FQHC providers, challenges specific to the patient population (e.g., elderly patients, homeless patients), complexities in adjusting clinic workflow, inadequate supply of specialists to provide telehealth services to FQHC patients, complex and time-consuming logistics around credentialing and licensing, and challenges in working with remote providers. The report suggests several possible solutions that address stakeholder concerns directly as well as areas for further research -- including surveying "the policy environment faced by FQHCs nationwide and explore whether certain policies seem to be associated with greater utilization of telehealth." THE LARGER TREND Given the advantages of using telehealth in underserved communities or to treat vulnerable patients, it is important that state officials and safety-net providers come to a mutual understanding of what's standing in the way of telehealth expansion for these populations -- and modify or clarify policies accordingly. Exciting developments in telemedicine technology must be evaluated in the context of whether they will provide benefits to all users, particularly those with the most need. ON THE RECORD "Telehealth is widely recognized as a tool that can increase access to care and improve quality, and, given that FQHCs are experimenting with telehealth across the United States, it is highly likely that many have confronted challenges and implemented strategies that can benefit others at different stages of implementation," the report authors write. "Studies such as this can support Medicaid programs and FQHCs in the important process of peer learning. Furthermore, our findings highlight the important role of policy, in combination with cultural, organizational, and infrastructure factors, in strengthening the delivery of telehealth services." Deirdre Fulton is communications professional and freelancer based in Maine. On Twitter: @deirdrefulton Healthcare IT News is a HIMSS Media publication. 

Although engaging with the NHS remains a challenge, companies now have more "accessible deployment opportunities", according to the research.

Given high levels of physician burnout and widespread disdain for EHRs, physicians actually have mixed feelings about EHRs, data and analytics.

A lot of attention is focused on network access security; it can be easy to overlook the vulnerability of data at the edge.

Hutt Valley District Health Board (DHB) is using robots to process the 24,000 e-referrals it receives every year. Hutt Valley DHB is based in Lower Hutt, and covers an area including Upper Hutt, Wainuiomata and Eastbourne, located in the Wellington region of New Zealand. The DHB, along with Wairarapa and Capital and Coast DHBs, has recently embarked on a project to automate the Mental Health Intake Assessment process. Former chief information officer at Hutt Valley Shayne Hunter spoke at the HiNZ 2018 conference in Wellington last November about the e-referrals automation project. He said this was previously an end to end process of manually registering and processing all e-referrals, estimated to require more than 4600 hours annually or the equivalent of 2-2.5 full time clinical administrators. “We embarked on a project to try and make that robotic,” he explained. During a 3-month pilot period, the robotic process automation attempted 681 e-referral registrations had an 83 percent success rate, saving an estimated 71 hours in staff time. For e-referral processing there were 900 attempts and a 75 percent success rate, saving 56 hours. He said there were problems with the data coming in, such as missing data, which means human interpretation is still sometimes needed. “It doesn’t have to be start to finish robotically, it can co-exist with humans in the process,” said Hunter. “We took the person from referrals and they’ve now become a virtual workforce manager to help automate other processes.” A plan to use robots to speed up basic clinical coding, so coders can spend more time on difficult coding scenarios, has been paused due to the high level of complexity. However, the Mental Health Intake Assessment project is moving ahead and the DHBs are hoping to be able to automate 100 percent of the process. Hunter added that the DHB is also looking at embedding AI to interpret the content where there is missing data. This article first appeared on eHealthNews.nz.

The Royal Australian and New Zealand College of Radiologists (RANZCR) is on a mission to improve decision-making transparency, data privacy and ethics in the industry’s use of AI and machine learning. In its draft Ethical Principles for AI in Medicine report, RANZCR calls for the “correct use” of AI and machine learning, specifically with regards to clinical radiology and radiation oncology, and includes the following eight guiding principles: Safety: Patient safety and quality of care should be the first and foremost consideration in the development, deployment or utilisation of AI or machine learning, with an evidence base to support it.   Avoidance of bias: As AI and machine learning systems are limited by their algorithmic design and the data they have access to, they are prone to bias. To minimise bias, RANZCR suggests that the same standard of evidence used for other clinical interventions be applied when regulating machine learning systems and AI tools, with their limitations transparently stated.   Transparency and explainability: As machine learning and AI can produce results which are difficult to interpret or replicate, RANZCR suggests that a doctor must be capable of interpreting how a decision was made and weighing up the potential for bias.   Privacy and protection of data: Storing a patient’s data must be done securely and in line with relevant laws and best practice. RANZCR suggests that patient data isn’t transferred from a clinical environment of care without the patient’s consent or approval from an ethics board. Where data is transferred or otherwise used for AI research, it should be de-identified in a way that the patient’s identity cannot be reconstructed.   Decision making on diagnosis and treatment: While machine learning and AI can enhance decision-making capacity, RANZCR suggests that final decisions on patient care are recommended by a doctor with due consideration given to the patient’s current state, history and preferences.    Liability for decisions made: The liability for decisions made about patient care rests with the responsible medical practitioner, while the potential for shared liability needs to be identified and recorded upfront when researching or implementing machine learning and AI.   Application of human values: As machine learning and AI tools are programmed to operate in line with a “specific world view”, RANZCR says it is the role of the doctor to apply humanitarian values (from their training and the ethical framework in which they operate) and consideration of that patient’s personal values to any circumstances in which these technologies are used in medicine.   Governance: RANZCR says that machine learning and AI are fast-moving technologies with the potential to add great value but also do harm. It suggests that a hospital or practice using these technologies have accountable governance committees in place to oversee implementation and ensure compliance with ethical principles and standards. [Read more: TGA draft guidance calls for heightened cybersecurity for medical devices | Standard bearers: The RANZCR’s journey to establish teleradiology protocols] These guiding principles were developed by RANZCR’s AI Working Group, which was recently established to determine how the technologies fit into the world of radiology and healthcare, and best practices around them. RANZCR President Dr Lance Lawler said these principles are “the first of their kind” devised by a healthcare body and that they aim to ensure the protection of patient data, balanced with the application of humanitarian values. “New technologies such as AI are having a huge impact on healthcare, with enormous implications for both health professionals and patients. They have the ability to help doctors work in a more time-efficient and effective manner and – ultimately – provide even greater treatment for patients,” he said. Lawler said these guiding principles are necessary as the way radiology adapts to AI has a flow-on effect for patients and other healthcare professionals. “The agreed principles will, when established, complement existing medicinal ethical frameworks, but will also provide doctors and healthcare organisations with guidelines regarding the research and deployment of machine learning systems and AL tools in medicine,” he said. "There are lots of hype and misinformation around AI; it is important to look beyond that and concentrate on… how we can best use it for the maximum benefit of patients.” The principles are out for public consultation, with submissions due before April 26.

Before finding her niche in cybersecurity, Agio Compliance Director Deana Fuller found herself in a situation familiar to many. She had dreams growing up of becoming a teacher or an attorney, yet found herself working in a profession where she didn’t belong. It was in sub-prime finance, earning bonuses for selling cars that had been repossessed. “My boss told me I needed to be more motivated,” Fuller said. “He said, in five years, you could become a branch manager making $50,000. This was the most motivating thing he could have said.” Fuller’s motivation carried her through several degrees. After getting a bachelor’s degree in English in 1992, she earned an MBA in 2002 and then went to the University of South Dakota School of Law. “I wanted to make more money and do more things,” she said. She found, during a class on administrative law, that she was very good at culling and deciphering information from complicated reports. When she went to work in 2009 for a primary care association as a business development director coordinating group purchasing, her boss asked her to read an Office of the National Coordinator report that had just come out. It was the 700-page ONC report on meaningful use. “My employer said, ‘Read this and tell us what it says,’” she said. She did, and her career moved in the direction of healthcare technology, privacy and security. Fuller has worked as a HIPAA privacy consultant, senior security and privacy compliance analyst, and adjunct professor teaching courses in health information technology management and healthcare law. She is a former senior consultant for A-LIGN, doing General Data Protection Regulation, or GDPR, gap readiness assessments, HIPAA and HITECH services and HITRUST assessments. Last year, when Agio needed someone to come in to build up the HITRUST program, Fuller became compliance director and associate director of Cyber Security Compliance, managing data protection. The company offers integrated managed IT and cybersecurity services to the financial services, healthcare and payments industries. WOMEN IN HEALTH IT A woman in the field of healthcare IT may find herself surrounded by men, Fuller said during HIMSS19 last month in Orlando, Florida. Fuller makes her home in Sioux Falls, South Dakota. “We are the minority,” she said. “We need more people, more diversity, other people’s opinions. I think we have more technical acumen than we have been given credit for.” Her recommendations for achievement can be found on her desk, she said. There sits an inspirational talisman of sorts, a plastic, miniature velociraptor that sends the visual message to “collaborate, then attack,” she said. “We can accomplish just about anything when we work together and support one another’s efforts to grow, learn and bring change.” There’s also a “no” button, a “sorry I’m late, I didn’t want to come” pencil holder that tells her to take ownership of her mistakes and a shot glass from “Hamilton” that serves as a reminder not to throw away what could be your best shot for success. “Don’t walk away from an opportunity because it scares you,” Fuller said. “Finally, I would say to honor your team. Without my team, I wouldn’t have had the opportunities or success I have enjoyed.” Twitter: @SusanJMorse Email the writer: susan.morse@himssmedia.com