Electronic Health Records (EHR, EMR)

HealthlinkNY and HealtheConnections will leverage best practices and team skills of both health information exchanges to improve care delivery, officials said.

The EHR vendor wins best Overall Software Suite and in two other categories, while Impact Advisors and Premier score top marks for Overall IT Services and Management Consulting firms, respectively.

The provider organization is being honored at HIMSS19 for its work using clinical data technology to better treat PTSD.

Companies will show the new tech at HIMSS19.

An implementation plan for a nationally consistent Electronic Oral Health Record (EOHR) will be presented to the country’s 20 district health board (DHB) chief executives by the middle of this year. Professional services organisation TAS is leading the implementation on behalf of the DHBs after recently signing a contract with the Ministry of Health. Chair of the EOHR programme board Robin Whyman is clinical director oral health at Hawkes Bay DHB. He says the programme started around 2015–16 because staff operating oral health services recognised that, while nearly all DHBs are using the same clinical system, differences in local implementations mean they are unable to get nationally consistent information out of it. “When trying to get information for a national picture of what’s going on in oral health and around service quality improvements, we were struggling to compare things and be confident we were interpreting things in the same way,” he added. All but two small DHBs are using Titanium Solutions and the remaining are paper based. A number of Māori health providers contracted to the DHBs are also using the software. The Titanium system contains critical information about the status of patients and treatments provided to nearly all children up to the age of 12 and some adults. However, each DHB has made its own decisions with the vendor, resulting in boards being on different versions of the software and two slightly different code sets for treatments being used. A Request for Proposal for a national EOHR system was released in November 2016, but the EOHR Programme Board recommended not to award a contract. Instead the programme team is working with Titanium to make improvements and move towards a nationally consistent system. “One of the early pieces of work is to work with the sector to allow a nationally agreed code set for the system,” Whyman says. “By having a consistent coding set and interpretation we believe we will start to have conversations about quality improvement, looking at outcomes of treatment and oral health status and how that’s linked to interventions put in place.” He hopes to have a national coding set in place and in use by mid-2019. Whyman says the board is also looking to develop regional groupings of DHBs using the same instance of the software. These will evolve over the next couple of years. “Part of the work of TAS is to work with the sector on the best way to do that,” he says. An implementation plan that’s “achievable within the resources of the DHBs” will be presented to the 20 DHB chief executives by the middle of this year for approval, he says. A TAS statement says a nationally consistent EOHR is expected to help improve New Zealanders’ oral health through improved capture and quality of oral health information. It says the programme of work underway will see DHBs implementing consistent business, system and information management processes. It will also enable DHBs to benefit from national economies of scale and achieve efficiency benefits. This article first appeared on eHealthNews.nz.

As the Federal Government today pushes the button to create My Health Records for every Australian who wants one, the industry has stepped out asking for more transparency around security and secondary use of the records to enable people to make more informed decisions about it. The industry has also voiced out about data de- and re-identification, a global approach to cybersecurity issues as healthcare digitises, information security requirements of the future and blockchain as a way to alleviate some of the challenges associated with the My Health Record system.   On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division. The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time. The date of 31 January follows much deliberation from the Federal Government to extend the opt-out date. Australians initially had until 15 October 2018 to opt out of the national health database, or a My Health Record was to be created for them by the end of that year. But following the opposition calling for an extension to the opt-out period, the public outcry against the potential for the data to be shared with police and other government agencies, a leaked government document detailing the Australian Digital Health Agency’s response to concerns and a raft of changes recommended by the Senate Inquiry into My Health Record, the Federal Government pushed this date back and relaxed its stance on when Australians can opt in or opt out of the system. Australian Academy of Technology and Engineering (ATSE) President Professor Hugh Bradlow said the collection of health data across the population will result in better health outcomes as it not only shows how effective interventions are, but also allows treatments to be personalised based on the experience of thousands of other patients. “New forms of measurement (based on artificial intelligence) will also give patients far more significant information about institutional performance, practitioner performance, the outcomes of specific interventions, etc.” he said. The Society of Hospital Pharmacists of Australia (SHPA) Chief Executive Kristin Michaels said the My Health Record debate highlighted the need for an integrated ehealth system, accessible only to health professionals and set up at the request of health organisations, for the benefit of all Australians. "All Australians, regardless of any illness or condition, deserve to get the highest-quality care,” Michaels said. “More often than many would think, patients are unable to explain the medicines they are already taking and for what conditions they are already being treated, particularly after a seizure or if unconscious. Many of these patients are unaccompanied. Sometimes this lack of information leads to errors that have serious impacts on people’s lives. “[Hence] hospital pharmacists have long called for a shared, electronic patient data system that links up a fragmented health system and empowers patients in their own care." THE ISSUE OF SECURITY However, University of Melbourne Department of Computing and Information Systems Cybersecurity Senior Lecturer Associate Professor Vanessa Teague expressed her concerns around the privacy implications of secondary uses of My Health Records not being accurately explained. "The My Health Record privacy policy says: ‘It is expected that most applications which are assessed will be for the use of de-identified data. This is where your personal details are removed from the dataset and you cannot be identified.’ Unfortunately, removing obvious personal details (such as name, location, and date of birth) does not securely de-identify the data,” Teague said. “Both doctors and patients can be easily and confidently identified in a dataset… In the case of patients, this means that a few points of information, such as the patient's age and dates of surgeries or childbirths, is enough to identify the person and thus, retrieve all their Medicare bills and PBS [Pharmaceutical Benefits Scheme] prescriptions for many years. “Easy and confident re-identification has been demonstrated on numerous other datasets that were shared in the mistaken belief that they were de-identified. It is probably not possible to securely de-identify detailed individual records like My Health Records without altering the data so much that its scientific value is substantially reduced.” [Read more: My Health Record system data breaches rise | Game changer: Creator of FHIR writes about approaching critical mass and a growing data sharing revolution] Teague said patients may choose to opt out of secondary uses of their data but are unable to make a “genuinely informed decision” if they are inaccurately told that their detailed record cannot be identified. “Even more importantly, those whose identifiable MBS [Medicare Benefits Schedule]-PBS records were already published in 2016 should be notified, because the earlier release could make re-identification of their My Health Records much easier,” she said. Harvard Medical School International Healthcare Innovation Professor Dr John Halamka also previously criticised the system for relying on outdated technology, saying that the $2 billion My Health Record was nothing more than “digitised paper” as it uses such “out-of-date” technology that crucial patient information on test results and diseases are unable to be read or shared by computers. University of Wollongong School of Computing and Information Technology Professor Katina Michael said health data breaches, for some, could have a huge impact. She used the recent example from Singapore, where 1.5 million Singapore health records were breached in a highly targeted effort on SingHealth. Among the breached health records was Singapore Prime Minister Lee Hsien Loong's personal records. “What does this tell us when one of the world's most advanced cybersecurity nations suffers such a large-scale attack? Plainly, that no one's personal information is safe, no matter the measures in place,” she said. "If we have learnt anything over the last four months, it is that electronic health records are hackable. We need not have to look too far to see that no system is impenetrable.” Michael also speculated that there is the possibility of a ramp up of blockchain initiatives to beef up on My Health Record security. “We will likely be told in the not too distant future that we wildly underestimated our security requirements and as such, must go one step further and protect our credentials,” she said. According to Professor Michael, this involves the implant of a 16-digit Personal Health Record (PHR) ID number into people that also reads vital signs while embedded. This technology then alerts first responders of ailments and medications without the need for the person to provide any information.     [Read more: Australia leads the world in personal control of electronic health records | Is the My Health Record technology out of date?] ATSE’s Bradlow said the industry needs to be “realistic” about it as the danger of data leaking due to cyber hacking is as true as hacking any other data system. “Let’s remember that many [healthcare professionals] have easy access to today’s paper-based health records – an electronic record is actually a step up in privacy. Within My Health Record, we can make it the default to require a patient access code,” he said. “A well-designed record system which is managed by a professional security organisation and has a clear audit trail, for example, provided by blockchain, can mitigate this risk significantly."

China's Kunming Children's Hospital put the power of IT to work to improve quality, safety and efficiency – and achieve Stage 7 of the EMRAM, says the organization’s president, Tiesong Zhang.

SA Health is expected to scrap and reconstruct its troubled electronic patient records system following an independent review of the program. The EPAS Independent Review found that the beleaguered Enterprise Patient Administration System (EPAS) failed as it “contrasts with other successful EMR implementations in Australia”. This conclusion was reached after an expert panel assessed the software solution supplied by Allscripts, its configuration and management by SA Health, and the implementation and governance of the program. The report identified that SA Health chose to implement the system without the assistance of “expert organisations including the Allscripts vendor” resulting in the billing module not being fit-for-purpose. In addition, it found that EPAS has a flawed governance model with “accountability for outcomes poorly understood and managed” and a lack of current governance arrangements empowering clinicians to be key decision-makers. It also found the governance model doesn’t enable the implementation of the system to be tracked, measured or managed, amongst other determinations. “The Review Panel concludes that all three factors have contributed to EPAS not meeting user expectations,” the report stated. The South Australian Government commenced implementation of EPAS in 2011, which it expected to deliver by 2014 at a cost of $421.5 million. But, by 2018, it claimed that 78 per cent of the funds for the original scope “had been expended.” Following public debate and change of government in March 2018, the rollout of EPAS was paused to commission an independent review to inform decisions on the most appropriate way forward, which resulted in the EPAS Independent Review. “The review finds that the EPAS program has been a failure and should be discontinued and replaced. The review has determined that the EPAS program should not continue as planned,” the South Australian Government said in response to the review. “The review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a roll out at two exemplar sites before a final decision is made on whether to continue to use the Allscripts suite of products.” [Read more: SA Health launches taskforce after claims of lost and delayed pathology results caused by new IT system | Xenophon calls for SA’s EPAS to be paused and investigated, while new RAH suffers a power outage mid-surgeries] The EPAS Independent Review also made 36 recommendations for a proposed way forward. “Every effort should be made to optimise the underlying elements of the EPAS program,” it stated. This includes improvements to Sunrise EMR (Electronic Medical Record), an integrated suite of clinical and financial solutions that is also used by hospitals and health systems in the US, UK, Canada and Singapore, and Allscripts PAS (Patient Administration System) implementation – terms that will replace EPAS. Allscripts ANZ General Manager Todd Haebich said the company welcomes the independent review into EPAS. ‘We look forward to working more closely with SA Health to fulfil what it has set to out achieve – the establishment of a state-wide electronic medical record,” he said in a statement. Other recommendations include the creation of an SA Health Digital Strategy with a Digital Health Board and “significant governance reforms” that put control into the hands of clinicians. “The Government will transition from the EPAS project to a new electronic medical record project, which will utilise two Allscript software programs, a patient administration program and an electronic medical record program,” the South Australian Government said. “Deployment to the exemplar sites will be the focus of immediate action for Government, with deployment to take place during 2019.”

As the Office of the National Coordinator for Health IT comments period drew to a close, a number of organizations weighed in about how to improve electronic health records platforms.

As suicides increase and the opioid crisis continues, Congress, HHS and others need to do more to enable data sharing for at-risk patients.