The value of learning health systems in disease control and aging

We are living in an unprecedented revolutionary age of science and technology. Real‐time databases of disease‐specific registries are expected to dramatically and efficiently accelerate clinical research studies. The use of real‐world data to augment data from randomized clinical trials is gaining traction and support globally. The article entitled “The Global Academic Research Organization Network: Data Sharing to Cure Diseases and Enable Learning Health Systems” in this issue describes the activities of the Global ARO Network, including a workshop with participants from Asia, Europe, and the United States. This network represents the global expansion of the ARO Council and global disease‐specific consortia that collaborate on disease‐specific registries. Such networks enable research on a global scale to test drugs and medical devices from academia, ushering in an age where we can collaborate on research and obtain approval for new therapies simultaneously around the world. The formation of global networks for patients with rare diseases is an essential step toward overcoming such diseases, and we now have a more specific picture of the expanded role that these networks play in realizing global learning health systems.

Not only can learning health systems be beneficial in identifying the best treatments for individuals with specific diseases, but there is a role for functioning learning health systems to be more broadly applied to identifying ways to prevent diseases by leveraging and learning from the data from healthy individuals. In developed countries, aging populations pose an increasing social burden and a threat to the vitality of the society, particularly when many of the elderly are inflicted with chronic or debilitating diseases. The slogan, “society in which people in their 100s can remain active,” presages a society where no one is bedridden.* This idea may seem like an impossible dream, like eternal youth and immortality. However, there is an important role of learning health systems in resolving the age‐associated dilemma of extending life, along with quality of life, and controlling diseases that prevent most elderly individuals from being independent and active centenarians.

The full article can be downloaded below.  

Consumerism Will Spark Change Across the Industry: My Top Seven Health IT Predictions for 2019

As we prepare to take on the challenges and opportunities of a new year, let’s lay out some of the industry’s macro trends and what they might mean to us in 2019.

This year, there is a theme. As patients, we have an increasingly consumer-oriented mindset—and rightfully so. We’re paying closer attention to the quality and value we’re getting for the money we’re spending. This “consumerization” of healthcare, along with constant technology innovation, is driving a tectonic shift across the industry, and it’s easy to be excited about what the future holds. 

After nearly 40 years in this business, I’d better be getting good at reading between the lines to understand what’s coming next. So without further ado, here are my top seven health IT predictions for 2019.

1. Consumerization of healthcare reaches tipping point
2. Telehealth, mobility and millennials will upend the who and where of care delivery
3. Consumers will demand healthcare price transparency
4. People will insist on the ability to easily share their health data -- forcing the industry to accelerate interoperability solutions
5. Increased interoperability will propel value-based care
6. Initially driven by government regulations, the health IT industry will take the lead on battling the opioid epidemic
7. The healthcare market will demand easier, more appropriate access to high cost specialty drugs

The full Surescripts article can be viewed at this link.  

Slides from 11.28.18 presentation by Robert Dieterle, CEO, EnableCare, LLC, at eHI's Simplifying Prior Authorization Executive Roundtable.

Slides presented by Viet Nguyen, Clinical Informaticist and Principle, Stratametrics, at eHI's November 28, 2018 Simplifying Prior Authorization Executive Roundtable meeting.

How Blockchain Technology Could Disrupt Healthcare

From managing patient data to tracking drugs through the supply chain, blockchain could solve some of the healthcare industry’s biggest problems.

The healthcare industry is plagued by inefficiencies, errors, bureaucracy, and high administrative costs.

Could blockchain technology help solve some of these challenges?

For all the hype, there’s no question that blockchain’s distributed ledger technology can offer real value for the healthcare industry.

Blockchain could help solve some of the industry’s most pressing compliance, interoperability, and data security issues, as well as enable new patient-centric business models.

But unlocking blockchain’s potential for healthcare will be a slow process, and change is unlikely to come fast.

In this report, we analyze where blockchain is likely to be integrated into healthcare in the short, medium, and long term, based on known stakeholders, scalability requirements, and necessary safeguards.

The full CB Insights report can be viewed at this link.  

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by healthcare professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network connected diagnostic devices for self-testing are needed to allow remote monitoring of patients’ health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

The full article can be downloaded below.  

FHIR Tools for Healthcare Interoperability

Electronic Health Records (EHR) is an essential element in human healthcare monitoring systems these days. As a large amount of data continues being archived and uploaded to healthcare repositories, virtually every second across the globe, vast amount of data mining tasks continue being modelled and modified to extract valuable decision support information. The Health Level 7 (HL7) consortium provides the framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice, management and delivery. With the large number of Internet of Things (IoT) health care kits becoming available it has become increasingly difficult to log the realtime patient monitoring information to healthcare repositories. As patients continue being monitored in real-time it has become essential that the trauma events information such as stroke or cardiac arrhythmia be uploaded to the EHR in real-time. Currently available monitoring devices can monitor and analyse an abnormal condition but may not be able to upload these events in real-time. The proposed research focused on developing real-time interoperability tools and services, which can enable wearable IoT devices to interact with the EHR in real-time and can provide real-time decision support.

The Fast Healthcare Interoperability Resources (FHIR) specification was used to develop and encode trauma related information in terms of FHIR resources, conceptual and logical models using clinFHIR tools. A HAPIFHIR application was implemented on an IoT device which could upload real-time ECG, PPG and relevant trauma information on a test FHIR server. The HAPIFHIR application code could encapsulate ECG arrhythmia, vital signs and trauma events in a single observation and could upload it to the HAPIFHIR server. Several such observations could be linked to a patient context and could be observed in real time in EHR. The ECG, the PPG, vital signs and trauma events were encoded according to Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) specifications. The alerts and alarms mechanism could assist the emergency response teams at the hospitals to prepare for an emergency well in time. An analogue front-end biomedical device was used for data acquisition and signal processing and the IoT devices were networked over wireless network to upload the events and observations to the FHIR server in real time. The system focussed on ‘preventive care’ as the next generation personalized health-care monitoring devices continue becoming available.

The full article can be downloaded below.  

Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

Recent decades have seen rapid growth in the implementation of Electronic Medical Records (EMRs) in healthcare settings in both developed regions as well as low and middle income countries. Yet despite substantial investment, the implementation of EMRs in some primary care systems has lagged behind other settings, with piecemeal adoption of EMR functionality by primary care physicians (PCPs) themselves. We aimed to review and synthesise international literature on the attitudes of PCPs to EMR adoption using the Clinical Adoption (CA) Framework. MEDLINE, PsycINFO, and EMBASE were searched from 1st January 1996 to 1st August 2017 for studies investigating PCP attitudes towards EMR adoption. Papers were screened by two independent reviewers, and eligible studies selected for further assessment. Findings were categorised against the CA Framework and the quality of studies assessed against one of three appropriate tools. Out of 2263 potential articles, 33 were included, based in North and South America, Europe, Middle East and Hong Kong. Concerns about the accessibility, reliability and EMR utility exerted an adverse influence on PCPs’ attitudes to adoption. However many were positive about their potential to improve clinical productivity, patient safety and care quality. Younger, computer-literate PCPs, based in large/multi-group practices, were more likely to be positively inclined to EMR use than older physicians, less-skilled in technology use, based in solo practices. Adequate training, policies and procedures favourably impacted on PCPs’ views on EMR implementation. Financial factors were common system level influencers shaping EMR adoption, from start-up costs to the resources required by ongoing use. By using the CA Framework to synthesise the evidence, we identified a linked series of factors influencing PCPs attitudes to EMR adoption. Findings underline the need to involve end-users in future implementation programmes from the outset, to avoid the development of an EMR which is neither feasible nor acceptable for use in practice.

The full article can be downloaded below.