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T.J. Samson Community Hospital announces job, salary cuts

T.J. Samson Community Hospital announces job, salary cuts | Healthcare and Technology news |
GLASGOW — Staff and salary cuts being implemented immediately at T.J. Samson Community Hospital are expected to result in savings of about $3.6 million between now and Sept. 30, according to the hospital’s interim CEO, Henry Royse.

Royse announced in a news conference Wednesday at the T.J. Health Pavilion that as many as 49 employees from across the hospital will lose their jobs. Meanwhile, wide-ranging salary reductions will affect any employee making more than $10 an hour, all the way up to senior management.

The salary cuts – 10 percent for senior management and salaried physicians, and between 2 percent and 6 percent for employees making more than $10 an hour – are effective through Sept. 30, but the personnel cuts are permanent.

“As this area’s leading health care provider, T.J. Samson has a responsibility to meet the health care needs of this community,” Royse said. “Our employees take tremendous pride in doing that each and every day. As leaders of T.J. Regional Health (the hospital’s parent company), we have a responsibility to do what’s right and best for the future and the long-term ability of us to serve the patients, to grow to meet the community’s needs and to meet our mission. Sometimes that means making tough, but necessary, decisions.” - See more at:

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Who is health care’s « Healthcare Economist

Who is health care’s « Healthcare Economist | Healthcare and Technology news |

That is the quesition PwC’s Health Research Institute (HRI) asks in it’s latest report.  Although the report does not make any specific predictions, there are some interesting case studies it presents.  Some of these case studies include:

  • Earlier this year, Samsung unveiled its new Galaxy S5 smartphone, complete with a built-in heart rate monitor. In 2013, Apple also was issued a US patent for a “seamlessly embedded heart rate monitor” for devices such as its iPhone. .
  • CVS Caremark announced it would stop selling tobacco products in its 7,600 stores as part of a strategy to expand its role as a healthcare company.
  • AT&T opened its mHealth platform to developers in 2012, aiming to become the essential ingredient in healthcare’s future game-changing apps.
  • Time Warner Cable Business Class announced a “virtual visit” experiment with Cleveland Clinic in 2013. Cleveland Clinic caregivers will be able to interact with patients through televisions using secure video technology.
  • In 2013, Google announced the birth of Calico, a company focused on aging and associated illnesses. Its chief has experience in both healthcare and consumer-oriented technology.

At a time when venture capital investment in life sciences is down, money is pouring into startups targeting digital health, price transparency, workflow and electronic medical records systems and population health management.

As the population ages and mobile health continues to grow, more and more firms will be looking towards getting into the business of health.

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BlackBerry invests in healthcare IT firm NantHealth

BlackBerry invests in healthcare IT firm NantHealth | Healthcare and Technology news |
BlackBerry has made a strategic investment with an end-to-end medical solutions provider by the name of NantHealth. As you can imagine, the health industry requires cloud connectivity while remaining secure, and NantHealth’s solutions, like BlackBerry’s, fall into that category. Specifics of the partnership are still being hashed out, but we can expect synergies to be found across QNX (which is already embedded in many vital pieces of medical machinery), BBM Protected, and devices. Here’s what BlackBerry CEO John Chen had to say on the partnership

“The future of BlackBerry lies in creative opportunities like this that take our many core disciplines and combine them in ways no one else can match. Healthcare is one of the key industries in which we have unique advantages and this investment reflects our commitment to maximize our opportunities there.”

It seems like a strange time to be making expenditures like this, but continuing to invest in the future is as vital to the survival of BlackBerry as keeping day-to-day costs down. How do you guys think BlackBerry could do with a concerted presence in the medical sphere? Do we have any readers in the industry already? How pronounced is BlackBerry’s presence there already?

WATERLOO, ONTARIO--(Marketwired - April 15, 2014) - BlackBerry Limited (NASDAQ:BBRY)(TSX:BB), a world leader in mobile communications, today announced an investment in healthcare IT leader NantHealth. The companies intend to collaborate on the development of HIPAA and other government privacy certified, integrated clinical systems that transform the delivery of medical care. NantHealth is a cloud-based medical IT provider transforming the delivery of healthcare for payers, providers and patients through real-time connectivity, high performance computing and 21st century decision support.

"This investment and planned collaboration aligns with the reliability, security and versatility of BlackBerry's end-to-end solutions - from the embedded QNX® operating system powering complex medical devices, to secure cloud-based networks, to instantaneous information sharing over BBM Protected," said BlackBerry CEO and Executive Chair, John Chen. "NantHealth is a proven innovator in developing leading platforms that allow medical professionals to share information and deliver care efficiently. BlackBerry's capabilities align closely with NantHealth's and this investment represents the type of forward-looking opportunities that are vital to our future."

Founded by medical entrepreneur Dr. Patrick Soon-Shiong, NantHealth works to transform clinical delivery with actionable clinical intelligence at the moment of decision, enabling clinical discovery through real-time machine learning systems. The company's technology empowers physicians, patients, payers and researchers to transcend the traditional barriers of today's healthcare system. The NantHealth platform is installed at approximately 250 hospitals, and connects more than 16,000 medical devices collecting more than 3 billion vital signs annually.

"BlackBerry's expertise is incredibly valuable to NantHealth as we expand our platform and make it available for wider deployment through a secure mobile device," said Soon-Shiong, NantHealth's founder and a pioneer of pharmaceutical treatments for both diabetes and cancer. "The future of the healthcare industry requires the ability to share information securely and quickly, whether device-to-device or doctor-to-doctor anywhere and at any time. The potential to integrate BlackBerry's secure mobile communications, along with the company's QNX embedded technology, will put the power of a supercomputer in the palm of the caregiver's hand. Providing actionable information at the time of need will significantly improve the efficiency of healthcare and, more importantly, the efficacy of care for the patient."

Details of the intended collaboration are being developed, but Chen and Soon-Shiong said they see significant opportunities because:

  • QNX is established as a real-time embedded operating system for mission-critical medical diagnostic and monitoring devices in hospitals and homecare environments;
  • BBM Protected is an upcoming, secure communication platform that could connect healthcare providers, field service workers, emergency personnel, patients and family members;
  • NantHealth's Clinical Operating System (cOS™) platform is the first operating system of its kind in healthcare. The platform integrates the knowledge base with the delivery system and the payment system, enabling 21st century coordinated care at a lower cost;
  • NantHealth and BlackBerry can combine secure cloud-based and supercomputing services to provide data integration, decision support and analytics; and
  • BlackBerry's devices are the global standard for secure communication and collaboration.

"The future of BlackBerry lies in creative opportunities like this that take our many core disciplines and combine them in ways no one else can match," said Chen. "Healthcare is one of the key industries in which we have unique advantages and this investment reflects our commitment to maximize our opportunities there."

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Anecdote-driven systems engineering and complaint-based interoperability design will not solve health IT woes

Anecdote-driven systems engineering and complaint-based interoperability design will not solve health IT woes | Healthcare and Technology news |

As I’ve been preparing to chair the HealthIMPACT conference in Houston next Thursday I’ve been having some terrific conversations with big companies like Cisco, some of our publishing partners, and smaller vendors entering the health IT space for the first time. One great question I was asked during a discussing yesterday by a tech publisher was “so what’s it going to take to achieve real interoperability in healthcare and how long will it take?” To that my answer was:

  • We need to move from anecdote-driven systems engineering to evidence-driven systems engineering and
  • We need to move from complaint-based interoperability design to evidence- and workflow-driven interoperability design

Although the discussion was over an audio telecon I could almost see the eyebrows being raised by the editors on the other side of the phone and could tell they were thinking I might be a little weird. I proceeded to explain that systems engineering and interoperability design in healthcare IT suffer from three major flaws:

  • The myth that there is a lack of interoperability
  • The myth that we don’t have enough standards
  • The assumption that health IT leadership has provided staff with the tools they need to do proper systems engineering and interoperbility design

The first myth is perpetuated usually through anecdote after anecdote by anyone who has ever had to fill out their name on two separate paper forms in a waiting room. The fact that you have to fill out forms (the anecdote) doesn’t mean that there isn’t interoperability — it just means that the cost of filling out a form is probably lower than the cost of integrating two systems. Healthcare systems are already interoperable in areas where they have to be — namely, where required by statue, regulation, or law. And, systems are interoperable where there’s a reimbursement (payment) reason to have it or in many cases if there’s a patient safety reason to have it (e.g. for Pharmacy or Lab Orders). Unfortunately, convenience and preference (e.g. for patients to not have to fill out forms twice) doesn’t factor into designs much right now because we have bigger fish to fry. If a non-integrated multi-system workflow isn’t demonstrably unsafe for patients, isn’t costing a lot of money that can be easily counted, or isn’t required by a law that will force leadership’s hands then complaining about lack of interoperability won’t make it so. We need to come up with crisp and clear evidence-driven workflow reasons, patient safety reasons, cost savings reasons, or revenue generating reasons for interoperability if we want improvement.

The second myth of lack of standards is perpetuated by folks who are new to the industry, looking for excuses (vendors do this), or are otherwise clueless (some of our health IT leaders are guilty of this). There are more than enough standards available to solve most of our interoperability woes. If we do workflow-based evidence-driven analysis of systems we come to see that most interoperability can be achieved quickly and without fanfare using existing MU-compliant standards. We have HL7, we have CCDA, ICD, CPT, LOINC, and many other format, transport, and related standards available. I’m not talking about flawless, pain free, error-free, interoperability across systems — I’m talking about “good enough” interoperability across systems where workflow reasons, patient safety reasons, cost savings reasons, or revenue generating reasons are clearly identifiable.

The third problem, lack of proper leadership, is probably the most difficult to tackle but perhaps the most important one. I’ve been as guilty of this as anyone else — we have many environments where we’re demanding interoperability and not giving the time, resources, budget, or tools to our staff that will allow them to prioritize and execute on our interoperability requirements. Leadership means understanding the real problem (workflow-driven, not anecdotal), making decisions, and then providing your staff with everything they need to do their jobs.

If we want to make progress in healthcare interoperability we need to train the next generation of leaders that proper systems engineering approaches are required, better interoperability is possible because some of it already exists now, and that you shouldnt wait for standards to get started on anything that will benefit patients and caregivers. Health IT integration woes can be overcome if we get beyond anecdotes and complaining and start doing something about it.

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Improved Survival For Men With Localized Prostate Cancer: Six Months Hormonal Treatment Combined With Radiation

Improved Survival For Men With Localized Prostate Cancer:  Six Months Hormonal Treatment Combined With Radiation | Healthcare and Technology news |

Based on new research, men with localized prostate cancer but at high risk for metastasis, have better outcomes if they are treated with radiation combined with androgen deprivation therapy which decreases testosterone, thus reducing chance for tumor spread and growth.

The research was presented at the 33rd conference of the European Society for Radiotherapy and Oncology (ESTRO-33) in Vienna on April 7. Findings from the study could represent a new approach to treatment of localized prostate cancer that is at high risk for spread.

“Although we need longer follow-up to assess the impact on these men’s overall survival”, said Dr. Michel Bolla, a professor of radiation oncology at Grenoble University Hospital, “these findings need to be taken into account in daily clinical practice.”

English: Micrograph of prostatic adenocarcinoma, conventional (acinar) type, the most common form of prostate cancer. Prostate biopsy. H&E stain. (Photo credit: Wikipedia)

“They show that three-dimensional conformal radiotherapy,” Bolla explained, “whether intensity modulated or not, and regardless of the dose level, has to be combined with short-term androgen deprivation therapy in order to obtain a significant decrease in the risk of relapse”. “Therefore, during multidisciplinary team meetings to discuss a patient’s treatment, this combined treatment approach should be one of the options proposed for men with localized prostate cancer that has an intermediate or high risk of growing and spreading,” added Bolla.

Intensity modulated radiotherapy (IMRT) is a version of 3-D radiation therapy that employs computer-generated images to demonstrate the size and shape of the tumor. This allows the size, shape, and intensity of the radiation beam to be altered to conform to the size, shape, and location of the patient’s tumor, reducing injury to nearby healthy tissue.

Bolla and colleagues evaluated 819 men at 37 sites in 14 countries. The patients had early stage prostate tumors (as confirmed by levels of prostate specific antigen (PSA) and biopsy) that were at moderate or high risk of metastasis.

The patients were randomized to receive either radiation alone or radiation and two injections of luteinizing hormone-releasing hormone analogues (LH-RH analogues), which reduce levels of testosterone to cause reversible chemical castration. Each drug injection lasted three months; the first drug was given on the first day of radiation and the second three months later.

When LH-RH analogues are initially administered, testosterone increases for a short period before dropping to low levels. This causes levels to sharply increase, (referred to as flare”. To reduce this response, patients took an oral anti-androgen (bicalutamide, 50 mg per day) for 15 days before the first injection.

In the study, treating physicians selected among one of three irradiation doses, 70, 74 or 78 Grays (Gy).  Follow-up was for an average of 7.2 years. Findings indicate that the 403 men who had been treated with radiation combined with anti-androgen therapy were significantly less likely to have suffered a relapse and progression of their cancer than the 407 men who had been treated with radiation alone, regardless of the radiotherapy dose and whether it was intensity modulated or not.

English: Human prostate specific antigen (PSA/KLK3) with bound substrate from complex with antibody (PDB id: 2ZCK) (Photo credit: Wikipedia)

Compared to men treated with radiation only, patients who received the combined approach had almost half the risk (47%) of biochemical progression of their disease. Compared with 201 men in the radiation only group, only 118 men in the combined treatment group had a biochemical progression of their disease. (Biochemical progression is defined by PSA values being elevated above the lowest level plus two nanograms per ml).

After five years, men in the combined treatment group were faring much better. “They had better survival without biochemical progression,” said Bolla. “Among those receiving the combined treatment, 17.5% had progressed compared to 30.7% receiving radiotherapy alone.”

Compared with 80.8% of men receiving radiotherapy alone, results  from the study demonstrated that five years after treatment, 88.7% of the men in the combined treatment group had not progressed.

Urinary difficulties were observed in 5.9% of patients receiving the combined treatment versus 3.6% of patients on radiation alone. Erectile dysfunction was higher in the combined treatment group, versus radiation alone. (27% versus 19.4%.

“These results show that, in men with localized prostate cancer that is at risk of recurring and spreading, the addition of six months of hormonal treatment to radiotherapy improves the time these men survive without their disease progressing,” stated Bolla. “It is important to ensure that the radiation treatment is of the best quality; further clinical research is required to optimize radiation techniques and to find new hormonal treatments.”

Dr. Vincenzo Valentini, president of ESTRO and a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, agreed.

“The results from this trial are important and practice-changing. It is clear that an additional six months of hormonal treatment in addition to radiotherapy improves the outcome for men with localized prostate cancer. This option should now be considered for all these men with prostate cancer that is at risk of growing and spreading.”

According to Dr. David Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, “For patients with early stage prostate tumors that are at the intermediate or high risk of growing or spreading to other organs, radiotherapy in conjunction with hormone therapy seems to give the patient a better outcome.” However, Samadi continues, explaining that “A lot of research points to the obstructive views of radiation with harmful side effects. This now gives the patient other options when determining how they want to pursue radiotherapy especially if chances of progression and relapse are minimal.”

One expert questions whether the authors’ conclusions are actually practice changing.

Dr. Louis Potters, Chairman of Radiation Medicine, North Shore-LIJ Cancer Institute in Lake Success, New York explains that Bolla is making “bold proclamations that these results are practice changing… But are they?”

Potters continues, stating that “while Dr. Bolla implies that hormones are necessary despite the dose, it is unlikely that the study was powered enough to prove the question of dose.”

“So is this study actually saying anything new? Well, perhaps not much,” Potters concludes.

“We know from many randomized-controlled studies that men with high-risk cancer require hormone therapy when using external beam radiation therapy. The question of hormone therapy for intermediate risk patients still remains in question. And from my initial read, it is not clear that this study truly closes the door on the question of adding hormones in men with intermediate risk disease,” explains Potters.

Why is this important? And what does dose have to do with it? We know, for instance that when using a seed implant (brachytherapy) in men with intermediate risk disease, the data does not appear to indicate the need for hormone therapy. And we know that the radiation dose for seed implants exceeds that of external beam therapy. Next, we know from recent data that men with intermediate risk disease do better with a combination of external beam radiation and seed implants as compared with external radiation alone.

“So the age-old question remains unanswered,” explained Potters. “That being whether high doses of radiation to treat prostate cancer are enough to cure most men with more advanced disease. Perhaps when using external beam radiotherapy in such patients, hormone therapy should be included,” added Potters.

“And for men interested in preserving potency and not having hormone-related side effects, they should consider a combination of external beam radiotherapy and seed implants and avoid hormones,” concludes Potters.

“Prostate cancer is a diverse disease”, explained Dr. Dennis L. Carter, a radiation oncologist with Rocky Mountain Cancer Centers, a practice in The US Oncology Network.

Carter discusses the fact that prostate cancers that have already spread to distant body sites are incurable and often impact both length of life and quality of life. In contrast, Carter explains that “very favorable prostate cancers most likely will never become life-threatening, and may not even require treatment. Much of the focus of research is in the realm of prostate cancers that are still localized, but are at low, intermediate, or high risk for spreading. “

“Such cancers may not even be causing any symptoms yet, but have the potential to become increasingly dangerous over time, “ Carter emphasized.

These types of cancers are initially treated with either surgery or radiation therapy.

“The addition of hormone therapy given for 4-36 months has previously been shown to improve outcomes, as shown in studies conducted by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC),” said Carter.

“Most of these previous studies were in patients with high risk features, and have shown that the prostate cancer blood test (PSA – prostate specific antigen) is less likely to rise, that cancer will be less likely to be found to recur in bones or lymph nodes, and that survival is prolonged with the addition of hormone therapy.” “Most of these previous studies focused on patients who are considered to be at ‘high risk’ for distant recurrence, and less is known about whether hormone therapy also helps patients with intermediate risk features, summarized Carter.

The proportion of patients considered to be intermediate risk is much higher than other previous studies.

“The current study is similar to those previously reported studies, but 75% of the men in this study were considered to be at intermediate risk for recurrence, with only 25% having high risk features.” “Survival was not shown to be better, though survival benefit is more difficult to prove because prostate cancer often takes a long time before it becomes life-threatening. “ added Carter.

“Longer term follow-up will show whether or not this early evidence of prostate cancer recurrence translates to a survival difference in the years ahead. In the meantime, this is early evidence that the addition of hormone therapy provides help to localized prostate cancer with intermediate risk for distant recurrence,” Carter conluded.

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Life as a Healthcare CIO: The March HIT Standards Committee

Life as a Healthcare CIO: The March HIT Standards Committee | Healthcare and Technology news |

The March HIT Standards Committee focused on the Standards and Interoperability (S&I) Framework projects for 2014, an overview of the 2015 Certification Notice of Proposed Rulemaking, and a first review of the standards maturity for the proposed Meaningful Use Stage 3 criteria.

Doug Fridsma presented the S&I update.  Importantly, a new initiative has been launched to coordinate decision support and clinical quality measures as related activities. EHRs should provide alerts and reminders from pathways, protocols, and guidelines intended to improve quality.  Also, a new initiative will connect EHRs and the Prescription Drug Monitoring Program (PDMP) to improve workflow, hopefully supporting single sign on and patient context passing so that PDMP data is one click away from any EHR.

Steve Posnack reviewed the 2015 Certification Notice of Proposed Rule Making, highlighting the changes from 2014.  He noted that the concept of the Complete EHR is no longer needed.   Providers buy the certified technology they need to attest and it may be that modules, an EHR, and an HIE meet all the attestation needs, not a single monolithic product.  The Implementation Workgroup will review the impact of the 50 new proposals in detail and we will discuss them at the April meeting.

I presented a task force review of the 19 Meaningful Use Stage 3 proposals.

Below are a few comments from the task force and the Standards Committee members.   Although the bulk of our comments focused on standards maturity, we also commented on provider impact and development difficulty, hoping to offer helpful “in the field” feedback to the Policy Committee.

Clinical decision support - it would be very challenging for an EHR to track every response to every decision support intervention and no standards exist for such tracking.  Maybe the best way to encourage decision support is via payment reform which links outcomes to pay.

Order tracking - there are standards for closed loop lab ordering but not closed loop referral workflow.   The Harvard Risk Management Foundation recently funded a project to define all the steps in closed loop referral management, pictured below.   Given the lack of standards and the development burden of this workflow, a focus on lab seems most appropriate.

Demographics/patient information - although standards exist for occupation and industry, other new demographic standards such as gender identify and sexual orientation are a work in process.  Here’s a great reference describing one approach. There could be a significant impact on EHR development if new demographics selections affect patient education materials, decision support, and quality measures.

Advance directive - a pointer to an advanced directive such as a URL would require little development and the standards are mature.

Electronic notes - Although the standards to transmit free text within a clinical summary are mature, the “high threshold” (likely over 50% of patients to have notes) could be a high burden first step.

Hospital labs - The HL7 2.51 standards are mature but a minority of hospital reference labs support comprehensive LOINC codes.

Unique device identifiers - The standard is well described but the implementation difficulty could be high if the electronic record had to validate the UDI against a national database and enable reporting on UDIs in the case of recalls.

View, download, transmit - the standards for clinical summaries are mature except for the representation of structured family history.  The requirement to make data available to patients within 24 hours could present workflow challenges.

Patient generated health data - certifying multiple methods of data capture creates a burden on developers.  Maybe a less prescriptive approach, focusing on the ability to receive patient data in some fashion would be best.

Secure messaging - overly prescriptive workflows could force the retooling of existing high functioning products.    Maybe a less prescriptive approach, focusing on the ability to support effective patient communication would be best.

Visit Summary/clinical summary - the nature of the clinical summary text (structured, unstructured, timeliness) could have workflow and development implications.

Patient education - the requirement is for only one language other than English and the Infobutton standard can support this.   A single language other than English may not achieve the policy outcome desired.

Notifications - although the HL7 admit/discharge/transfer standards are mature, the notion of gathering the Direct addresses of care team members and sending event data via Direct is a novel workflow.

Medication Reconciliation - identical to stage 2, no concerns

Immunization history - The HL7 2.51 content and CVX vocabulary standards are mature.  The transport specification created by the CDC (SOAP) is well tested.   The questions we raised - is there a role for Direct in transmitting immunization data to registries since Direct is used for other transmissions in Meaningful Use?   Is REST an alternative to all Meaningful Use “push” and “pull” transactions.   The public health community is passionate about the use of SOAP.   There are pros and cons to using something different for public health transport than other areas of Meaningful Use, so it is likely there will be further discussion.

Registries - the development effort required to submit provider chosen data elements to  registries would be significant.   Standards do not exist for this purpose.

Electronic lab reporting - identical to stage 2, no concerns

Syndromic surveillance - identical to stage 2, no concerns

There will be more discussion in upcoming meetings as both FACAs recommend iterative improvements as input before rule making.

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No work emails after 6PM please, we're French

No work emails after 6PM please, we're French | Healthcare and Technology news |

Sure, the French have it sweet with a 35 hour work week and five+ weeks of paid vacation. But (Mon dieu!) workers there are still bombarded with job-related emails when off the clock. Almost a million of them won't need to put up with such rude intrusions anymore, though. A legally binding deal signed by tech industry employers and several unions in France means many companies are now forbidden to contact employees electronically after their work day is over. The plan was hailed by worker groups, but not everyone was happy. France has a large digital sector, with a big presence by Google, Facebook and others, and many critics claim that France already has too much bureaucracy. Still, such labor-friendly laws are understandably popular with the public. Given all the cuisine, wine and other pleasures on tap, who wants to hear from le boss?

Filed under: Cellphones, Internet


Via: The Times (subscription)

Source: Les Echos

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The #1 paid app in the Google Playstore "Virus Shield" is a complete scam - Neowin

The #1 paid app in the Google Playstore "Virus Shield" is a complete scam - Neowin | Healthcare and Technology news |

Security is an important factor when it comes to technology, and in most cases you can never have too much. In 2014, our smartphones know more about us than we know about ourselves, and if malware were to creep onto our smartphones then we could potentially suffer some major consequences. As a result, like any reasonable person, we would look to secure our device. This is what Deviant Solutions, the creator of the current #1 Play Store app, decided to capitalize on.

Virus Shield claims it is an antivirus that "protects you and your personal information from harmful viruses, malware, and spyware" and "Improve the speed of your phone," and it does this all with one click. It also claims to have a minimal impact on battery, run seamlessly in the background, and if that wasn't enough, it also acts as ad-block software that will stop those "pesky advertisements." This app costs $3.99, has been on the Play Store for just under two weeks and has already had 10,000 downloads with a 4.5 star review from 1,700 people. 2,607 people hit the Google "recommend" button. This means that the app must be doing something right... right?

Unfortunately for the buyers, Android Police has discovered that all the app does is change a red "X" graphic to a red "check" graphic. Literally. The 859kb app doesn't protect, secure, or scan anything. More work went into the Settings menu than the actual "security" portion of the app, and it appears that thousands of users have been scammed out of their money.

For $3.99, you get to see the image on the left turn into the image on the right

In tracking down the creator, it appeared that the creator was a well known scammer who had been banned from forums for trying to scam people out of low-valued online game items.

This calls into question some concerns about the openness of the Play Store. Is a walled-garden approach where the app goes through a strict review process, similar to what currently takes place in Apple's App Store, a better model for smartphones? Or does the freedom that comes from Google's approach outweigh the negatives of a bad app creeping in every now and then?

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Report: Hospital CEO Turnover Rate Reaches 32-Year High

Report: Hospital CEO Turnover Rate Reaches 32-Year High | Healthcare and Technology news |

The turnover rate for hospital CEOs is the highest reported since the American College of Healthcare Executives began tracking these rates back in 1981, according to a new report from ACHE. In 2013, the turnover rate was 20 percent, while the annual rate has fluctuated between 14 percent and 18 percent in the previous decade.

By means of comparison, the turnover rate was 17 percent in 2012 and 16 percent in 2011 and 2010, respectively. The lowest reported rates by ACHE were 13 percent in 1990 and 1983.

ACHE compiles the hospital CEO turnover rates based on changes in an organization's executive structure as reported to the American Hospital Association.

“The increase in the turnover rate may be indicative of a combination of factors, including an increased number of baby boomers seeking retirement, the emerging trend toward consolidation in our industry and the complexity and amount of change going on in health care today,” said Deborah J. Bowen, president and CEO of ACHE, in a written statement. “The increase in the rate reinforces the need for health care leaders to work with their boards to ensure appropriate succession plans are in place.”

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Encore Presentation: WEDI's 10 Recommendations for Next-Generation HIE

Encore Presentation: WEDI's 10 Recommendations for Next-Generation HIE | Healthcare and Technology news |
Twenty years after the Workgroup for Electronic Data Interchange issued the WEDI Report that ushered in the HIPAA standards to automate health care administrative and financial transactions, the group in December 2013 released a roadmap to guide the next generation of health information exchange.

Patient Engagement: Standardize the patient identification process across the health care system.

Convene industry to identify best practices for patient matching, launch consumer awareness and education campaigns, initiate pilots and explore dissemination strategies, and launch an adoption campaign

Patient Engagement: Expand health IT education and literacy programs for consumers to encourage greater use of health IT to improve care management and wellness.

Identify curriculum and deployment strategies for standardized materials, pilot the materials, and launch educational and literacy programs.

Patient Engagement: Identify and promote effective electronic approaches to patient information capture, maintenance and secure appropriate access that leverages mobile devices and “smart” technologies.

Convene business and clinical experts to define the standard technology, data content and dissemination strategy. Identify mobile technologies and apps that easily provide users information in a timely manner. Pilot best practices and effectiveness.

Innovative Encounter Models: Identify use cases, conventions and standards for promoting consumer health and exchange of telehealth information in a mobile environment.

Map electronic encounters (telemedicine, email, text & care monitoring) by typical use, then develop a matrix showing how innovative encounters are typically used. Evaluate and prioritize the effectiveness of technology initiatives.

Innovative Encounter Models: Adopt and implement best-in-class approaches promoting growth and diffusion of innovative encounters that demonstrate value for all stakeholders.

Evaluate encounter models in terms of patient support & satisfaction, outcomes, ease of integration into workflow and liability issues. Assess and prioritize existing protocols and payment methodologies for electronic encounters. Survey consumer willingness to use and pay for electronic encounters.

Innovative Encounter Models: Identify federal and state laws that create barriers to innovative encounters, including licensure.

Continue monitoring for potential regulatory barriers and best practices. Create policy mechanisms and partnerships to get supporting legislation.

Data Harmonization & Exchange: Identify consistent & efficient methods for electronic reporting of quality and health status measures across all stakeholders, with initial focus on recipients of quality measure information.

Review existing methods and standards for electronic clinical quality measurement, develop a plan to get consensus on methods & standards, design and launch awareness campaigns, pilot standards and develop a plan to get industry adoption.

Data Harmonization & Exchange: Identify/promote methods & standards for HIE that enhance care coordination.

Review existing methods, standards and implementation guides to identify gaps that impede connectivity and timely sharing. Develop a plan for industry consensus on methods and standards, test them, and develop a plan for adoption.

Data Harmonization & Exchange: Identify methods & standards for harmonizing clinical and administrative information reporting that reduce data collection burdens, support clinical improvement and population health, and accommodate new payment models.

Review existing methods, standards and implementation guides to identify impediments to linking clinical and administrative data. Develop consensus on methods & standards supporting claims attachments and quality reporting in Stage 3, then pilot.

Payment Models: Develop a framework for assessing core elements of alternative models such as connectivity, eligibility/enrollment reconciliation, payment reconciliation, quality reporting and coordinated data exchange.

Assess technology needs to facilitate implementation of alternative models and educate stakeholders. Assess the technology market for existing solutions to aid implementing and adopting alternative models.

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Windows XP Support is Going Away: A HIPAA compliance issue? | Health Security Solutions

Windows XP Support is Going Away: A HIPAA compliance issue? | Health Security Solutions | Healthcare and Technology news |

In mid-2011, Microsoft officially announced the sunsetting of its popular Windows XP operating system. The 2011 announcement established April 8, 2014 as the official end of support for XP. Microsoft has a sunsetting policy, introduced in 2002 as the Support Lifecycle Policy, which establishes a ten-year minimum lifespan for operating system and software support. Windows XP was introduced in 2001, and Microsoft has continuously provided support for the program for nearly 14 years, despite the introduction of three newer Windows operating systems. No software company can support its applications indefinitely and Microsoft decided, in accordance with their Support Lifecycle policy, to discontinue XP support beginning in 2014. As a result, Microsoft will no longer be providing “new security updates, non-security hotfixes, free or paid assisted support options, or online technical content updates” for the XP operating system.




Are Windows XP users at risk of being non-compliant with HIPAA requirements?


Many eligible providers subject to HIPAA are concerned whether continued utilization of Windows XP will affect compliance with security requirements. While “non-compliant” may be too strong a term, unpatched machines are a real risk to covered entities. Following April 8, 2014, computers utilizing the Windows XP operating systems will become increasingly vulnerable due to a lack of security updates or “patches”. Unpatched machines present a security risk because they provide a vector for malicious software to infect machines and networks. Infections can then lead to the compromise of electronic protected health information (ePHI) stored in the affected machine or network. In addition to security vulnerabilities, continued use of Windows XP may become problematic, as many independent software vendors will cease to offer applications and updates for software utilized on the XP operating system.


Recommendations for Windows XP users


Because Microsoft will no longer be providing patches and support, we strongly encourage covered entities to update their operating systems to Windows 7 or 8. This type of update usually requires a hardware refresh, as many systems do not meet the requirements for Windows 7 and 8 operating systems. A recommended alternative to a hardware refresh involves the development of virtual desktop environments (VDE). XP machines can be deployed as virtual machines with the implementation of VDE, though this route should only be undertaken if the electronic health record (EHR) platform in use specifies that VDE may be used. Covered entities should endeavor to evaluate their current operating systems and the options available for upgrades, as utilization of XP after the end of support on April 8, 2014 will lead to increased vulnerability to breaches and the compromise of ePHI.

Technical Dr. Inc.s insight:

Technical Doctor, the #1 medical IT support company, can help you with HIPAA compliance.  Contact one of our team members at to learn more!

-          The Technical Doctor Team

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Pharmacies set to go big on Blue Button | Healthcare IT News

Pharmacies set to go big on Blue Button | Healthcare IT News | Healthcare and Technology news |

In efforts to guarantee patient access to their lab tests, the nation's largest pharmacies are now promising to adopt the Blue Button personal health record.


Walgreens, Kroger, CVS, Rite Aid, Safeway and pharmacies with the National Association of Chain Drug Stores are pledging to start standardizing patient prescription information within the next year to accommodate applications and services using the Blue Button.


"These steps will help patients access their prescription information and further empower millions of Americans to better manage their healthcare," U.S. deputy CTO Nick Sinai and HHS Presidential Innovation Fellow Adam Dole wrote on the White House Office of Science and Technology Policy blog.


Sinai and Dole argue that the new commitment from the pharmacies — some of them, like CVS, increasingly being a place for basic health services — will "fuel the growth" of Blue Button technologies and ultimately make it easier for more Americans to navigate their healthcare.


HHS and the ONC have been working with private and public sector organizations for several years now trying to popularize the Blue Button PHR, which evolved out of the Department of Veterans Affairs and was dubbed perhaps simplest, most promising consumer empowerment tool by former national coordinator Farzad Mostashari, MD.


More and more hospitals and physicians offices are working with Blue Button+ standards, which make it easier to share the records, and a "vast majority" will be doing so year as part of the personal health record requirements in second phase of meaningful use, Sinai and Dole said.


The pharmacies committing to the Blue Button expansion are in various stages offering personal health record technology, some already offering consumers their medication history and others just getting started.


Walgreens currently offers customers a view and download of their prescription history from a Blue Button-branded online portal and will adopt the BlueButton+ guidelines.


Kroger, a supermarket chain with a large presence in the Midwest and South, already offers about half of its pharmacy customers access to their Rx records in an online portal. As part of the new commitment, Kroger will be extending the portal to the rest of its stores, letting customers download a copy of their records and possibly offering them machine-readable records that can integrate with other apps.


CVS Caremark, now notable for abandoning tobacco sales, has been offering customers their medication list and Rx history online for download for some time, as has Rite Aid, with its own online portal.


Safeway, one of the newer members of the Blue Button community, will be catching up with some its peers in offering customers online access to their prescription data. Likewise for 41,000 pharmacies in the National Association of Chain Drug Stores.


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Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why | Healthcare and Technology news |

The CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per prov

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Johnson & Johnson Profit Jumps As Prescription Drug Sales Surge And Outlook Increases

Johnson & Johnson Profit Jumps As Prescription Drug Sales Surge And Outlook Increases | Healthcare and Technology news |

Johnson & Johnson JNJ +1.4% easily beat the Street with its first quarter earnings results Tuesday morning, reporting a 3.5% lift in revenue and a near-8% jump in profit thanks to strong sales in its prescription drug segment. As a result of the strong earnings figures, shares of Johnson & Johnson are trading higher Tuesday and the company has lifted its full-year outlook.

Johnson & Johnson, the maker of medicines like Tylenol and consumer products like Aveeno and Listerine, reported $18.1 billion in first quarter revenue, beating Street estimates of $17.99 billion and coming in 3.5% above the $17.5 billion reported for the first quarter of 2013. The company’s net income came in at $4.4 billion, a 7.8% increase over the same time last year and resulting in earnings of $1.54 per share, easily beating the analyst consensus of $1.48 in earnings per share.

The company’s results were boosted by its worldwide pharmaceutical sales, which grew 10.8% to $7.5 billion. Though Johnson & Johnson said products like Aveeno and Listerine were positive contributors to that worldwide sales figure, the company said the primary contributor to the sales growth were prescription drugs like Stelara, a drug used to treat moderate to severe plaque psoriasis and psoriatic arthritis, HIV drug Prezista and multiple myeloma treatment Velcade. Growth in these areas helped offset the negative impact of patent expirations for Aciphex, a proton pump inhibitor used for gastrointestinal disorders, and Concerta, a drug used to treat ADHD.

“Johnson & Johnson delivered strong first-quarter results driven by successful new product launches and the continued growth of key products,” Alex Gorsky, Johnson & Johnson chairman and CEO, said in a statement Tuesday morning. “Our talented colleagues around the world continue to bring meaningful innovations to patients and customers, addressing significant unmet needs. We also advanced our near-term priorities and long-term growth drivers, positioning us well to deliver sustainable results.”

After releasing lower-than-expected full-year guidance in its fourth quarter 2013 earnings results in January, Johnson & Johnson raised that forecast on Tuesday, saying it now expects full-year earnings to fall somewhere between $5.80 and $5.90 per share, excluding the impact of special items. The company had previously forecast full-year earnings in the $5.75 to $5.85 range.

Following the earnings beat, shares of Johnson & Johnson rose in Tuesday’s pre-market trading session and opened at $98.43 per share, up from Monday’s close of $97.14. Year-to-date, shares of the company are up 6.7%.

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The uselessness of volume-based hospital analysis « Healthcare Economist

The uselessness of volume-based hospital analysis « Healthcare Economist | Healthcare and Technology news |

Do hospitals with higher volumes have better outcomes? If hospitals specialize or providers learn-by-doing, hospitals with more admissions or more procedures may have higher quality. A paper by Hentschker and Mennicke (2014) examine just this question and find:

We define hypothetical minimum volume standards in both conditions and assess consequences for access to hospital services in Germany. The results show clearly that patients treated in hospitals with a higher case volume have on average a significant lower probability of death in both conditions [aortic aneurysm and hip fracture]. Furthermore, we show that the hypothetical minimum volume standards do not compromise overall access measured with changes in travel times.

The bigger question is, is this an important finding? I would say the answer is ‘no’. Even if it is the case that bigger hospitals perform better, requiring patients to go to high-volume hospitals is likely only optimal in a short-run equilibrium. In the long-run, prohibiting small hospitals from doing certain procedures in essence will give large hospitals increased market share and perhaps even a pseudo-monopoly. Thus, in the long-run quality will likely suffer. Further, new entrants with innovative surgical techniques would be barred from the market since they do not have sufficient volume.

Even if volume is highly correlated with quality, a preferred alternative would be to distribute this quality information more widely to patients. Even if policymakers wished to restrict access only to the highest quality hospitals, it would make more sense to prohibit patients from going to low-quality hospitals directly rather than using a proxy.

In some cases, quality measures may be incomplete. In this case, volume may serve as a good proxy for quality. However, without good quality measures, it is difficult to verify if this the case.

In summary, knowing whether high volume hospitals have better quality outcomes is an interesting academic finding, but has little practical application.

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Why do Avon sales reps selling makeup deserve better usability than hospital physicians saving lives?

Why do Avon sales reps selling makeup deserve better usability than hospital physicians saving lives? | Healthcare and Technology news |

I was watching the Super Bowl tonight and lost interest after Bruno Mars’ very nice halftime concert so I started picking up some “Read it Later” articles I saved late last year; one specifically caught my eye. In December the Wall Street Journal (WSJ) reported that Avon is pulling the plug on a $125 million software system rollout which “has been in the works for four years after a test of the system in Canada drove away many of the salespeople who fuel the door-to-door cosmetics company’s revenue”. Read the following excerpt from the WSJ article and imagine any EHR company company in place of “SAP”, switch “representatives” for “care givers” and replace the word “sales” with “patient care”:

While the new system based on software supplied by SAP AG worked as planned, it was so burdensome and disruptive to the representatives’ daily routine that they left in meaningful numbers. Avon relies on a direct sales model where its representatives aren’t employees, which makes it difficult to add new tasks associated with the software system.

After four years and $125 million dollars in investment, which is commonplace for large software rollouts and certainly on the low end for large EHR rollouts, some courageous Avon executives said “enough is enough” and chose their sales people (the revenue generators) over the vendors.

While most physicians working at hospitals could also be considered “independent representatives,” could we imagine many CIOs or CEOs in large health systems doing the same after spending millions of dollars? How about tens of millions? How about hundreds of millions? Is there enough courage in large health system C-suites to go against the billion dollar EHR vendors and choose the well being of patients and productivity of providers?

I know that there are just as many non-healthcare CIOs who are not courageous enough to go up against large software vendors but their employees don’t have much choice and aren’t independent physicians that drive large amounts of revenue. I guess usability of EHRs will only get significant attention when independent physicians are willing to leave hospitals in large enough numbers.

One could say that the only reason Avon killed the project was that the sales reps had a choice to switch to their competitors, but it’s worth wondering if sales reps selling makeup deserve better usability than healthcare providers saving lives.


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How Will Boomer, Gen-X, Millennial Doctors Respond To Health Care Changes?

How Will Boomer, Gen-X, Millennial Doctors Respond To Health Care Changes? | Healthcare and Technology news |
How Will Boomer, Gen-X, Millennial Doctors Respond To Health Care Changes?

With American health care in the midst of rapid transformation, both doctors and patients will be forced to adapt to changes stemming from the Affordable Care Act, also known as “Obamacare.”

Of course, everyone responds to change differently. But is it possible to predict how doctors will adapt to health care reform based on the year they were born? The answer may surprise some patients and even force them to think differently about who provides their care in the future.

How Different Are The Generations, Really?

A lot of data exists on the characteristics that define and differentiate generations. While none of that data can paint a totally accurate picture of any one doctor, the research does allow us to cover the canvass in broad strokes:

Baby Boomers (born 1946-1964) are known for their work ethic and long-term commitment to a single organization. They’ve been willing to trade work-life balance for professional success, recognition and financial security.

Generation Xers (born 1965-1983) are comfortable moving between jobs and don’t see themselves working for any one organization their entire lives. They tend to prioritize a balanced lifestyle over financial gain.

Millennials (born 1984-present) expect to work with multiple employers and seek out cross-cultural and global opportunities. They too value flexibility in their work-life balance. They don’t mind working hard but want to be judged on their output and results, not the total number of hours they put in.

And compared to their predecessor generations, millennials have a disproportionately stronger entrepreneurial spirit and prefer to work in efficient, fast-moving, team-based organizations.

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

How Generations Of Doctors Will Handle Change

Not all generational generalities are foolproof: Some baby boomer physicians are as high-tech as the savviest millennials and plenty of Generation X doctors put in long hours.

But on the whole, there are fundamental differences in doctors’ work styles, communication habits and overall fondness for change in the context of a rapidly evolving health care world.

Bidding Farewell To The Solo Practice

Many baby boomer physicians spent entire careers building up small and solo practices. But once they retire, will newly trained millennial physicians rush to buy up their practices? Not likely.

Research from the past decade shows a growing number of residents seeking salaried employee positions at hospitals, health systems and other health care organizations.

Whereas boomers value the independence of running their own office – and having their name on door – younger generations of doctors prefer the greater work-life balance and predictability that larger employers offer.

But what about the millennial generation’s “entrepreneurial spirit”? Will they be able to drive change in relatively rigid hospital and health care systems or will they be stifled? Hopefully, many of the next generation will choose to redirect their entrepreneurial energy by taking on leadership roles within larger organizations. For now, it remains to be seen how younger doctors will cope with the frustrations and complexities of the current health system’s bureaucracy.

Saying Hello To ACOs  

Being a part of an accountable care organization (ACO) means physicians practice less as individuals and more as a team.

This change seems best suited for millennials who enjoy group projects and don’t mind sharing success. In addition, both Gen-X and millennial doctors will appreciate the freedom that group practice provides. Younger doctors will embrace being off the clock because they’ll be more comfortable trusting the skills of their colleagues.

Despite the growing benefits of larger group practices, one traditional benefit won’t likely to appeal to emerging generations. That is, the long-term benefits packages designed to encourage physicians to stay with a single medical group for their entire career.

Younger physicians value the freedom to shift jobs and will be unimpressed with retirement packages that don’t pay out for another 30 years.

So, while Gen X and Gen Y are likely to join medical groups for the team-based aspects, it may be the boomers in the group who are the most committed to the long-term success of the group and who will take on the demanding leadership roles of new ACOs.

The Doctor Will Text You Now

The generational gap may be most pronounced in the use of technology for clinical care. Today’s patients are increasingly interested in obtaining virtual care through email and video.

Baby boomers may be the lone holdouts here.

In general, boomers value building face-to-face patient relationships and are less familiar with mobile devices (just ask their kids). They worry about the potential malpractice risks associated with not seeing patients in person. They’ll likely want to continue delivering personal medical care in traditional ways.

Tech-savvy Gen-Xers will embrace the flexibility technology gives them. Being able to work “on the go” should help them balance their workday with family responsibilities and personal commitments. But they may be disappointed to discover that being constantly connected limits their ability to disconnect from work.

Ultimately, the millennials will lead the way in adopting these 21st century tools. They take new technology as their birthright and, having come of age with social media, they are “sharers” who are wholly at ease with communicating information in bits and pieces.

But their comfort with technology raises an interesting question: Will health care’s most successful millennials even be doctors? A growing number of newly trained millennial physicians are skipping clinical medicine entirely and taking their ideas directly to market as health care technology entrepreneurs.

Working Smarter, Not Longer

As physician reimbursement models move from pay-for-volume to pay-for-value (rewarding high-quality clinical outcomes), the three generations may find themselves on common ground.

The value-based model offers a welcome respite for boomers who can hark back to a time when they didn’t have to churn through a large number of patient visits every day. In the new era of pay-for-value, they will be rewarded for providing high quality care and satisfying their patients – a very high priority for them.

Pay-for-value is equally attractive to younger generations of physicians who want workday flexibility. They’ll prefer outcome-based compensation over approaches that emphasize clocking into their office and having to stay longer to earn more income.

How Will These Generations Work Together?

Three things above all else will challenge each of the three generations of doctors: health care reform, new technologies and the need to make health care more available and affordable.

Baby boomers may find the pace of change exhausting. But over time, they may prefer tomorrow’s quality-focused workflow to today’s revolving door of patients.

And contrary to their current plans, boomers may end up reluctant to retire due to their increasing longevity, financial pressures and the centrality of work in their lives. With all the speculation surrounding a boomer-inspired physician shortage in the future, delayed retirements may end up being a short-term solution to balance patient-doctor ratios.

At the other end, millennial physicians are just starting their careers. They are likely to find their expectations of work-life balance at odds with their desire to quickly pay off a decade’s worth of student loans.

They may also bristle with the lack of technology in today’s medical practice. Will that lack of high-tech frustrate them or serve as an opportunity to create meaningful change? Either way, they will be the group that most quickly embraces new approaches while rejecting the past.

The most interesting thing to watch will be how physicians representing each of these generations interact with one another in the workplace, particularly as they share patient-care responsibilities.

Each generation may help their colleagues practice in new and different ways for the benefit of all. However, their cultures may be so different that coordination, communication and collaboration will suffer.

Whether health care reform proves successful or not may depend on how physicians across the U.S. collaborate. The stakes are very high for all and only time will tell which path our nation goes down.

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Will you 'like' the doctor who tells you you're dying?

Will you 'like' the doctor who tells you you're dying? | Healthcare and Technology news |

Editor's note: Dr. Mary F Mulcahy is an associate professor in the hematology oncology department at Northwestern University Feinberg School of Medicine, and a co-founder of Life Matters Media, which provides information and support for those involved in end of life decision-making. The opinions expressed in this commentary are solely those of the author.

(CNN) -- Honesty may be the best policy, but when delivering bad news to patients, physicians must prepare to pay a price for that honesty.

You simply do not like the doctor who tells you what you are afraid to hear. In this age of greater accountability in health care, the satisfaction of patients and the subtle nuance of likeability is connected directly to doctor payment. And patients who don't like what their doctor tells them won't "like" that doctor on the growing number of physician rating services springing up on the Internet.

The complex task of adding unwelcome and difficult content to a conversation may impede physicians from having dialogues about the most sensitive issues. Often these hard conversations arrive as a patient nears the end of life.

Mary Mulcahy

Martha, 65, came to see me for a second opinion regarding her incurable pancreatic cancer. She could accurately describe the extent of her disease, its implications and her goals of "buying more time" with therapy.

Aware of the dismal survival statistics, Martha remained hopeful about recent therapeutic advances reported in the media. We were able to discuss a treatment plan that set reasonable goals, and she told me she was very grateful.

However, she then described the "cruel" physician she had seen prior to our visit who told her "there was nothing more to do" and to "go home and die." Martha was surprised that there was no disciplinary action to be taken against this doctor.

What was the doctor's crime? She had the unfortunate duty of being the first person to tell Martha the truth.

Knowing this doctor -- a compassionate, thoughtful and experienced oncologist with superb communication skills -- I knew those words weren't the ones she actually said.

By the time Martha arrived in my exam room, she had stirred the information around in her head, digested the statistics and had found a hopeful morsel. A little of the bitterness was blanched out.

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While there are some doctors who knowingly give false hope, most believe in the principle of veracity -- a term used in medicine to denote the ethic of truth-telling.

However, veracity applies to both happy news and sad. When addressing those with terminal or life-limiting illnesses, I may be a good cop today -- yet tomorrow -- maybe a bad one.

How patients perceive a difficult, yet honest, conversation can impact the confidence and satisfaction they feel with their doctor.

A recent study reported in The New England Journal of Medicine evaluated patients' understanding of their cancer treatment goals. More than 70% of advanced cancer patients enrolled did not understand that they had an incurable disease.

Using a five-item questionnaire, patients rated physician communication. Those patients rating high scores for physician communication were more likely to respond inaccurately to the inquiry into the goal of their chemotherapy regimen. Responses suggest that many patients perceive physicians as better communicators when conveying more optimistic views.

The implications of these findings are enormous. In the comedic parody "Anchorman 2," the bumbling Ron Burgundy changes the tactics of television news by giving people what they want, not what they need.

The result is a sensationalized newscast of car chases and puppy stories, devoid of any public value. This mentality of enablement is seen regularly in medicine -- the skyrocketing number of Cesarean sections and the overuse of antibiotics are telling examples.

By doling out what patients want instead of what they need, many physicians become known as 'good' doctors.
Mary Mulcahy

By doling out what patients want instead of what they need, many physicians become known as "good" doctors.

An underlying and ambitious aim of the Affordable Care Act is the improvement of health care quality. Attempting to disprove Robert Pirsig's take in the book "Zen and the Art of Motorcycle Maintenance": "Even though quality cannot be defined, you know what quality is," numerous programs have been implemented to measure the quality of hospitals, physicians and medical systems. At best, these metrics are inexact and complex.

Concrete measures, such as morbidity (the prevalence of disease) and mortality, have long been used with associated and well-established limitations. Clearly, hospitals treating the most medically complex patients will also suffer higher rates of mortality than others. Likewise, those institutions in underserved areas will be hampered by limitations in social services and patient compliance.

In an effort to obtain more accurate quality measures, numerous private and government-funded organizations have emerged using various tools to gauge outcomes -- both system and patient-reported.

Patient-reported outcomes reflect the status of a patient's condition in his or her own words, without the interpretation of a clinician or anyone else. Resources allowing patients to rate their health care experiences are increasingly littering the Internet; , and are just a few of myriad examples.

These consumer-oriented, online medical report cards intend to stimulate quality improvement efforts among practitioners. However, an unforeseen consequence is that they may act as a sounding board for unhappy patients with no distinction between ineffective systems and unfortunate circumstances.

Barriers to honest, difficult conversations about terminal illness, the end of life and the limitations of modern medicine are numerous.

In these days of instant "likes" that can impact physician payment without the tools to distinguish a conversation's quality from its content, physicians may feel pressured to provide patients with the answers they want -- instead of the critical answers they need.

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Deadline for Medicare EPs to Attest Fast Approaching | EHR Blog | AmericanEHR Partners

Deadline for Medicare EPs to Attest Fast Approaching | EHR Blog | AmericanEHR Partners | Healthcare and Technology news |
Deadline for Medicare EPs to Attest Fast Approaching

Reminder: Medicare Eligible Professionals Must Attest by March 31 at 11:59 pm ET to Receive 2013 Incentive
Providers should submit data as soon as possible and during non-peak hours to avoid system delays.

The last day eligible professionals can register and attest to demonstrating meaningful use for the 2013 reporting year of the Medicare EHR Incentive Program is March 31, 2014. Eligible professionals must successfully attest by 11:59 p.m. Eastern Daylight Time on March 31 to receive an incentive payment for 2013 participation.

Payment adjustments for eligible professionals will be applied beginning January 1, 2015, to Medicare participants that have not successfully demonstrated meaningful use. For more information, visit the payment adjustment tipsheet for eligible professionals. Providers must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment. Review important dates for the EHR Incentive Programs using this Interactive Timeline.

The above information was provided by CMS and is reproduced here in its entirety.

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Health Insurance Exchange Enrollment: March 2014 Update « Healthcare Economist was seen as a disaster. Some states, however, opted to create their own exchange. California, for instance, created the “Covered California” website and exchange. How many states decided to create their own exchange? A Robert Wood Johnson issue brief notes that:

[Sixteen] States (and DC) established their own marketplaces; 27 states chose, or defaulted to, a federally-run marketplace. Because of time constraints, two of the state-based marketplaces (New Mexico and Idaho) are using the federal IT platform while they develop their own.

In which States did the exchanges lead to the largest update in insurance?

The enrollment rate varies from state to state, with a high of 54% in Vermont to a low of 5% in Massachusetts. We should note that Massachusetts had the lowest rate of uninsurance in the nation since its health reform in 2006; its previous success might mean that the remaining uninsured population could be especially difficult to reach…

On average, state-based marketplaces have had higher enrollment rates (20.3% of eligibles) than the federally facilitated ones (12.4%) or the partnership states (13.9%).

Note, however, that these figures represent the share of individuals who were uninsured or who had previously had an individual plan (i.e., not Medicare, Medicaid, or an employer-provided group plan), and thus these estimates somewhat overstate the impact of ACA on uninsurance rates.

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Is it still safe to use Windows XP?

Is it still safe to use Windows XP? | Healthcare and Technology news |

"Change is hard, both in terms of moving information and in learning a whole new OS. But if security is important to a company — and it should be — changing to a more recent and more secure OS is the only option".

Technical Dr. Inc.s insight:

After April 8, 2014, Microsoft will no longer support the Windows XP operating system. There will be no more security fixes, software updates or technical support, although Microsoft will still provide some anti-malware support for an unspecified amount of time.


Computers that continue to run Windows XP will be at increased risk for malware infection after April 8, yet many businesses have critical XP-only applications. Others can't afford to upgrade to new PCs. How much of a risk are they running?


MORE: Best PC Antivirus Software 2014


Microsoft has given Windows XP users plenty of warning that XP support will end soon, but a study released in January by cloud-services provider Evolve IP found that nearly one in five information-technology decision makers were unaware the so-called "XPocalypse" was coming.


Cloud-security firm Qualys recently found that although there has been a steady decline in the number of computers using XP, at least 15 percent of U.S. companies still run the 13-year-old OS.


It's clear that there are a lot of companies, both large and small, that need to upgrade their computers. Small and medium-sized businesses with tiny or outsourced IT staffs may not have the time or the budget to do so before April 8.


Jackpot for hackers

A lack of software support can create security problems.


"Every standard desktop-security risk that a computer faces will be amplified, because there are no fixes being written by Microsoft," said Scott Kinka, chief technology officer at Evolve IP in Wayne, Pa.


'To some extent, patching Windows 7 or 8 provides a potential road map to hackers into XP machines.'

- Scott Kinka, chief technology officer at Evolve IP

"This involves every form of malware possible," Kinka said. "Just assume someone is on your PC while you're working. Every password, trade secret and bit of personal information is at risk."


Most versions of Windows are based on previous versions, Kinka added, and patches to the newer versions could put XP users at greater risk.


"When an exploit is identified in a newer operating system that is still widely used, it's generally also a risk on older versions of the operating system," Kinka said. "As a result, Microsoft has made it a practice to patch all of their supported operating systems at the same time."


Let's say a vulnerability is found and patched in Windows 7 a few months after April 8, when there will still be millions of people using XP. When the update comes out, not only will XP not be patched, but hackers can examine the Windows 7 update to learn where the same vulnerability exists in XP.


"You just invited them in the front door," Kinka said. "To some extent, patching Windows 7 or 8 provides a potential road map to hackers into XP machines."


It's also important to remember that it isn't only the OS that loses support at the end of a Windows life cycle.


When Microsoft stops supporting Windows XP, it will also stop supporting Office 2003. Many third-party developers will follow suit and end support for XP-compatible versions of their own software. Users may not be able to call those manufacturers for assistance with critical software that runs on XP.


"End of support will not just affect the operating system," Kinka said, "but every piece of software that runs on it — whether it's written by Microsoft or not."


There is some good news, however, regarding Web browsers and anti-virus software. Google will support the XP version of its Chrome Web browser until April 2015, and Mozilla has no plans to stop updating Firefox for XP. Most anti-virus software makers plan to support XP until at least April 2016.


A possible workaround

Windows XP users may already be experiencing problems with software upgrades. Operating systems evolve with every iteration and become more sophisticated with the addition of new features that serve an increasingly demanding ecosystem of software, peripherals and users, said Victor Thu, director of desktop product marketing at virtualization-software maker VMware in Palo Alto, Calif.


As a result, the most up-to-date OS usually takes up more memory and requires faster processors than its predecessors in order for users to take full advantage of its advanced capabilities.


Wolfgang Kandek, chief technology officer of Qualys in Redwood Shores, Calif., said there are three types of users who continue to use XP: those unaware of the impending end of support, those who don't care and those who use Windows XP-specific software or applications.


"The third category is those that we can more effectively encourage to move over to a more secure operating system," Kandek said. "You don't have to abandon or change the applications you use just because Windows XP is losing its support — a common misconception. Users can simply isolate the applications and run them via the built-in Windows XP Mode within Windows 7 [Professional, Enterprise or Ultimate editions]."


Such XP-enabled virtual machines give Windows 7 users the best of both worlds:  updated, more secure operating systems without the cost and hassle of updating applications. (Microsoft recommends "you only use Windows XP Mode if your PC is disconnected from the Internet" after April 8, 2014.)


MORE: How to Migrate From Windows XP Before Microsoft Pulls the Plug


While Windows 7 is not the most recent version of Microsoft's operating system, it is one of the most secure and it is well supported by IT administrators. (Windows 8 does not include Windows XP Mode.)


No matter what the reasons are for staying with Windows XP, its users will be significantly less secure beginning April 9. Vulnerabilities will be forever left unpatched, and attackers are expected to take full advantage of them.


Change is hard, both in terms of moving information and in learning a whole new OS. But if security is important to a company — and it should be — changing to a more recent and more secure OS is the only option.




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How do Contracted Health Care Staffers Feel about Their Work?

How do Contracted Health Care Staffers Feel about Their Work? | Healthcare and Technology news |
Contracted health care professionals are generally satisfied with their chosen occupation, according to results of a recent survey.
Contracted health care professionals are generally satisfied with their chosen occupation, according to results of a recent survey.

At least the employees of Medical Staffing Network Healthcare, which offers a variety of clinicians and other professionals primarily in hospitals but also in other settings, seem content. The company asked employees in January to anonymously respond to its 2014 Pulse of the Healthcare Industry survey and got about 1,650 responses. The results:

* Fifty-eight percent are confident in their job security and two-thirds feel fulfilled.

* Eighty-six percent would recommend the health care profession to future workers.

* While 60 percent do not expect to seek another job within six months, 35 percent are looking for a change.

* Nearly equal numbers of respondents have positive, negative or uncertain views of the industry’s future under the Affordable Care Act.

* Rate of pay is the most important workplace attribute, followed by flexibility, location and schedule. Environment and benefits ranked almost as high, with lagging attributes being co-workers and career goals.
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University of Miami Health System loses patient records |

University of Miami Health System loses patient records | | Healthcare and Technology news |

The University of Miami Health System (UHealth) has lost patient records containing protected health information (PHI), according to a report by Miami New Times. The Health System, which is one of Southern Florida’s largest health providers, learned of the missing records on June 27, 2013, but has only recently begun to notify patients.

While the UHealth has not disclosed the number of missing records, they have announced that the files contained patient names, dates of birth, physician’s name, insurance company name, medical record name, visited facility, visit number, procedures, diagnostic codes, and Social Security numbers. The records were described as billing vouchers, and medical were records were not believed to be at risk.

In June, the Department of Otolaryngology contacted an off-site storage vendor to locate the records, but the vendor was unable to do so. After searching for the records, the health system confirmed on August 28, 2013 that the files were lost. Affected patients were notified this week.

UHealth has not received any reports of misused information, but they are offering affected patients credit monitoring services. However, considering the fact that patients are only being notified of the event over six months later, it is unlikely that affected patients would have connected any potential fraud to the hospital prior to notification.

According to UHealth’s statement, it will report the incident to the Department of Health and Human Services (HHS):

"At the University of Miami Health System, we take the privacy and security of our patients’ information very seriously. We continue to review and refine our physical and electronic safeguards to enhance protection of all patient data. We are committed to protecting all information entrusted to us, and pursuant to the Federal HITECH Breach Notification Rule, we will report this incident to the U.S. Department of Health and Human Services."

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Interoperability lag drags mHealth down

Interoperability lag drags mHealth down | Healthcare and Technology news |

Interoperability lag drags mHealth down

February 07, 2014 | Anthony Brino - Contributing Editor

  A cardiac patient of the Robert Wood Johnson University Health System was having problems at about 2 a.m. She was wearing a telemetry monitor that notified her doctor, who, in turn, got the catheterization lab ready even before the patient arrived at the hospital.


But there is a harsh reality underlying that particular example.


"There are 10 other things like that we could be doing,” CEO Stephen Jones said. If not for the cost and complexity of interoperability, that is, including the “millions and millions" of dollars that Robert Wood Johnson spends on interfaces.


Joseph Smith, MD, the West Health Institute’s chief medical officer, said many people have been wondering aloud whether fully interoperable information systems and medical devices could help avoid some of the many preventable deaths each year.


If the last decade of health information management was defined by digitization, the next will be defined by the pursuit of standardization as a foundation for efficiency and innovation. That road is destined to be long and winding, however, as two standards conveners and regulators in the Office of the National Coordinator for Health IT and the U.S. Food and Drug Administration acknowledged.


But need it be so complex?


One long-time hospital executive asked that of the ONC’s chief science officer, Doug Fridsma, MD, and the FDA’s devices and radiological health director, Jeffrey Shuren, MD, during Healthcare Innovation Day this week in Washington, D.C.


If Congress can mandate universal health insurance, after all, why not universal data and device interoperability?


“Keep saying that,” Fridsma urged. Shuren added: “They’re pushing.”


But by law the FDA can't actually mandate standards compatibility across products; rather, it has to approve devices based on the developers’ intentions, Shuren explained.


And top-down mandates are not necessarily the best solutions, especially in a country as large and diverse as the United States, Fridsma added.


Fridsma said the U.S. government is taking the right approach by “doing it from the middle” and trying to corral patients, providers, health plans and technology companies and helping to align their incentives.


Shuren said the FDA will likely incentivize interoperability standards for devices, if not necessarily mandating them.


How long that takes and how much new interoperability can be created remains to be seen, however.


In the meantime, Glenn Tobin, CEO of the Advisory Board Company’s Crimson division, posed a question perhaps on the minds of many people.


“Are patients dying because of this?”


Not in the case of the Robert Wood Johnson cardiac patient, fortunately, but the Institute of Medicine attributes 200,000 to 400,000 annual hospital deaths to preventable adverse events each year.

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Midwestern HIEs join forces | Healthcare IT News

Midwestern HIEs join forces | Healthcare IT News | Healthcare and Technology news |

Two Midwest health information exchanges, Tiger Institute Health Alliance and Lewis and Clark Information Exchange, are now able to share the data of 2.5 million patients across Missouri and Kansas.


TIHA, based in Columbia, Mo., and LACIE, based in Kansas City, Mo., enacted an agreement by which data exchange incurs no connection fees for either network, member providers or patients, officials say.


Linking the two HIEs connects 30 hospitals and more than 4,000 physicians operating at more than 500 clinics and other care venues – such as emergency medical services, long-term care and home health – that use several differentelectronic health record systems.


"As Americans become more mobile, they are receiving healthcare from different providers, often in different cities," said Harold A. Williamson Jr., MD, board chair of the TIHA and vice chancellor of the University of Missouri Health System, in a press statement.


"This data sharing will allow physicians to view their patients' medical records from other healthcare organizations instantly, giving physicians more information to make the best healthcare decisions," he added.


Children's Mercy Hospitals and Clinics Chief Medical Information Officer Laura Fitzmaurice says her organization sees "countless” patients from Missouri and Kansas.


"This partnership between LACIE and TIHA means Children's Mercy will have access to more patient information than ever before," said Laura Fitzmaurice, chief medical information officer of Kansas City-based Children's Mercy Hospitals and Clinics, who says her hospital serves patients from both states.


"As a physician, I'm encouraged because we will make better decisions for our patients and, as an administrator, I'm excited to deliver this service to our employed and affiliated physicians," she said, in a press statement.


Mike Dittemore, executive director of LACIE said this new data sharing will bring immediate results.


"We are now sharing medical records among patients' healthcare providers in different cities – even different states – all within months of agreeing to do so," he said in a statement. "This connection to the Tiger Institute Health Alliance is the most significant connection LACIE has made to date."


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