Characteristics of Mail-Order Pharmacy Users: Results From the Medical Expenditures Panel Survey

This study has identified several key factors that affected the use of mail-order pharmacies, such as age, race, marital status, income level, education level, insurance status, and having a prescription with at least a 30-day supply. Living in rural areas did not affect the use of mail-order pharmacies. Insurance policy makers should consider those characteristics in promoting the utilization of mail-order pharmacies.

The full article can be downloaded below.  

Clinical Research and Data: HIPAA, the Common Rule, the General Data Protection Regulation, and Data Repositories

The inexorable march of Moore’s Law has resulted in changes in all areas of our lives, including how we do clinical research. Researchers and patients are more connected. We store, access, and manipulate data in different ways; we conduct studies in multiple countries sharing data and samples around the world; and cybersecurity and hacking are a reality. This article touches on different legal aspects arising at the intersection of technology, data, and clinical research— specifically HIPAA (the Health Insurance Portability and Accountability Act), human subjects research, the European data law (the General Data Protection Regulation), and data repositories. It attempts to explain how two different law-making bodies, the US and the EU, have tried to balance the necessity of using data for research purposes that benefit society with the privacy issues and risks of that same data.

The full article can be downloaded below.  

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

Electronic health records (EHRs) have emerged among health information technology as "meaningful use" to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records’ use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose. Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE (PubMed), 10/02/2012–10/02/2017, core clinical/academic journals, MEDLINE full text, English only, human species and evaluated the articles that were germane to our research objective. Each article was analyzed by multiple reviewers. Group members recognized common facilitators and barriers associated with EHRs effect on population health. A final list of articles was selected by the group after three consensus meetings (n = 55). Among a total of 26 factors identified, 63% (147/232) of those were facilitators and 37% (85/232) barriers. About 70% of the facilitators consisted of productivity/efficiency in EHRs occurring 33 times, increased quality and data management each occurring 19 times, surveillance occurring 17 times, and preventative care occurring 15 times. About 70% of the barriers consisted of missing data occurring 24 times, no standards (interoperability) occurring 13 times, productivity loss occurring 12 times, and technology too complex occurring 10 times. The analysis identified more facilitators than barriers to the use of the EHR to support public health. Wider adoption of the EHR and more comprehensive standards for interoperability will only enhance the ability for the EHR to support this important area of surveillance and disease prevention. This review identifies more facilitators than barriers to using the EHR to support public health, which implies a certain level of usability and acceptance to use the EHR in this manner. The public-health industry should combine their efforts with the interoperability projects to make the EHR both fully adopted and fully interoperable. This will greatly increase the availability, accuracy, and comprehensiveness of data across the country, which will enhance benchmarking and disease surveillance/prevention capabilities.

The full article can be downloaded below.  

Clinic to in-home telemedicine reduces barriers to care for patients with MS or other neuroimmunologic conditions

In this survey study, analyzing experience with clinic to in-home telemedicine in our academic MS and neuroimmunology clinic, travel and caregiver burden were reduced with the convenience of televideo-enabled visits while preserving efficient and effective care in the opinion of both patients and clinicians. These results support the integration of clinic to in-home telemedicine within the continuum of MS/neuroimmunology specialty care.

The full article can be downloaded below.  

Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research

People and health systems worldwide face serious challenges due to shifting disease demographics, rising population demands and weaknesses in healthcare provision, including capacity shortages and lack of impact of healthcare services. These multiple challenges, linked with the global push to achieve universal health coverage, have made apparent the importance of investing in workforce development to improve population health and economic well-being. In relation to medicines, health systems face challenges in terms of access to needed medicines, optimising medicines use and reducing risk. In 2017, the International Pharmaceutical Federation (FIP) published global policy on workforce development (‘the Nanjing Statements’) that describe an envisioned future for professional education and training. The documents make clear that expanding the pharmacy workforce benefits patients, and continually improving education and training produces better clinical outcomes.

The opportunities for harnessing new technologies in pharmacy practice have been relatively ignored. This paper presents a conceptual framework for analysing production methods, productivity and technology in pharmacy practice that differentiates between dispensing and pharmaceutical care services. We outline a framework that may be employed to study the relationship between pharmacy practice and productivity, shaped by educational and technological inputs.

The analysis is performed from the point of view of health systems economics. In relation to pharmaceutical care (patient-oriented practice), pharmacists are service providers; however, their primary purpose is not to deliver consultations, but to maximise the quantum of health gain they secure. Our analysis demonstrates that ‘technology shock’ is clearly beneficial compared with orthodox notions of productivity or incremental gain implementations. Additionally, the whole process of providing professional services using ‘pharmaceutical care technologies’ is governed by local institutional frames, suggesting that activities may be structured differently in different places and countries.

Addressing problems with medication use with the development of a pharmaceutical workforce that is sufficient in quantity and competence is a long-term issue. As a result of this analysis, there emerges a challenge about the profession’s relationship with existing and emerging technical innovations. Our novel framework is designed to facilitate policy, education and research by providing an analytical approach to service delivery. By using this approach, the profession could develop examples of good practice in both developed and developing countries worldwide.

The full article can be downloaded below. 

New tool helps doctors determine which patients are most likely to forget or skip their appointments

Patients who don't show up for their scheduled medical appointments drain health care providers' time and resources, reducing appointment availability, increasing wait times, and reducing patient satisfaction.

In an effort to solve this problem, a team of researchers from the Johns Hopkins University's Malone Center for Engineering in Healthcare has developed a new algorithm that can reduce no-show rates and increase appointment availability.

The full article can be viewed at this link.  

Medical Device Cybersecurity: Regional Incident Preparedness and Response Playbook

Cybersecurity attacks on Healthcare and Public Health (HPH) critical infrastructure, such as healthcare delivery organizations (HDOs), are occurring with greater frequency. Disruptions in clinical care operations can put patients at risk. The global ransomware event known as WannaCry demonstrated how the performance of vulnerable medical devices may be compromised by an exploit, whether it intentionally targets the healthcare system or is purely opportunistic. Similarly, other attacks such as Petya/NotPetya have highlighted key challenges in preparedness and response across the HPH critical infrastructure sector. Securing critical infrastucture is a shared responsibility across many stakeholders, and with respect to medical devices the primary stakeholders are FDA, Medical Device Manufacturers (MDMs), and HDOs.

A common preparedness and response challenge FDA heard from its stakeholders in the aftermath of the aforementioned attacks is that HDOs did not know with whom to communicate (e.g. MDM-HDO interactions); what actions they might consider taking; and what resources were available to aid in their response. Without timely, accurate information and incorporation of medical device cybersecurity into their organizational emergency response plans, it was difficult for HDOs to assess and mitigate the impact of these attacks on their medical devices. To address this unmet need, the MITRE team (with the support of FDA), engaged with a broad distribution of stakeholder groups to understand the gaps, challenges, and resources for HDOs participating in medical device cybersecurity preparedness and response activities. These stakeholders included HDOs of varying size and demographics, state departments of health, medical device manufacturers, and government agencies. Information gathered resulted in the creation of this playbook that may serve as a resource for HDOs. The playbook provides a stakeholder-derived, open source, and customizable framework that HDOs may choose to leverage as a part of their emergency response plans in order to ultimately limit disruptions in continuity of clinical care as well as the potential for direct patient harm stemming from medical device cyber security incidents.

The full playbook can be downloaded below.  

A quick look at the UK's new National Health Service app

The National Health Service (NHS) in England is introducing a new app that will allow patients to access NHS services on their smartphones and tablets, to be gradually rolled out across the country starting from December this year.

Developed by NHS Digital and NHS England, it will be available through the App Store and Google Play for patients aged 16 and over, who will be able to use the app to access their GP records and the NHS 111 symptom checker, book appointments, order repeat prescriptions, register as organ donors and set data sharing preferences, using a single identity verification system.

The full article can be viewed at this link.  

Mabu, a robot helping patients with congestive heart failure, is working with the American Heart Association

Catalia Health today announced that it has formed a partnership with the American Heart Association (AHA) to bring AHA-approved content on heart attacks and strokes to Mabu, a personal health assistant robot working to reduce congestive heart failure patients readmission to hospitals.

Mabu is similar to robots like Pillo in that it’s designed to remind patients to take their medication, but it also offers education and tracks patient activity to better help those diagnosed with congestive heart failure.

The full article can be viewed at this link.  

Trusted Multi-Party Computation and Verifiable Simulations: A Scalable Blockchain Approach

Large-scale computational experiments, often running over weeks and over large datasets, are used extensively in fields such as epidemiology, meteorology, computational biology, and healthcare to understand phenomena, and design high-stakes policies affecting everyday health and economy. For instance, the OpenMalaria framework is a computationally-intensive simulation used by various non-governmental and governmental agencies to understand malarial disease spread and effectiveness of intervention strategies, and subsequently design healthcare policies. Given that such shared results form the basis of inferences drawn, technological solutions designed, and day-today policies drafted, it is essential that the computations are validated and trusted. In particular, in a multi-agent environment involving several independent computing agents, a notion of trust in results generated by peers is critical in facilitating transparency, accountability, and collaboration. Using a novel combination of distributed validation of atomic computation blocks and a blockchain-based immutable audits mechanism, this work proposes a universal framework for distributed trust in computations. In particular we address the scalaibility problem by reducing the storage and communication costs using a lossy compression scheme. This framework guarantees not only verifiability of final results, but also the validity of local computations, and its cost-benefit tradeoffs are studied using a synthetic example of training a neural network.

The full article can be downloaded below.