Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren’t used at all by the very people who may need them most.

The report, Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics, was published this month in the Clinical Journal of the American Society of Nephrology.

“Electronic health record patient portals allow individuals to access their medical information with the intent of patient empowerment,” researchers write. “However, little is known about portal use in nephrology patients.”

The study tracked patients seen between Jan. 1, 2010, and Dec. 31, 2012, at four university-affiliated nephrology offices; each of the patients had at least one additional follow-up visit before June 30, 2013. Researchers abstracted sociodemographic characteristics, comorbidities, clinical measurements and office visits from the EHR and also tracked median household income for patients’ neighborhoods for added context.

Of 2,803 patients, 1,098 (39 percent) accessed the portal. Of those, more than 87 percent of users reviewed their laboratory results, 85 percent reviewed their medical information, 85 percent reviewed or altered appointments, 77 percent reviewed medications, 65 percent requested medication refills and 31 percent requested medical advice from their renal provider, according to the CJASN study.

But in adjusted models, characteristics such as being older, being African-American, being insured by Medicaid or living in a neighborhood with lower median household income “were associated with not accessing the portal,” according to researchers, who pointed to factors such as data security concerns or lack of confidence or skills in accessing health information online as potential barriers.

“While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it,” the report concludes. “Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them and their potential to improve outcomes.”

“Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable,” Khaled Abdel-Kader, the study’s lead author, told NPR. “As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on.”

Access the study here.

Article source: http://www.healthcareitnews.com/news/does-health-it-exacerbate-care-disparities

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Arlington, VA (October 27, 2015) – HIMSS applauds the Senate for passing S. 754, The Cybersecurity Information Sharing Act (CISA) of 2015. CISA marks an important step forward in creating an infrastructure to promote greater sharing of cyber threat information between government and the private sector.

In particular, HIMSS strongly supports provisions in the bill aimed at addressing the cybersecurity needs of the healthcare sector. This includes the creation of an industry task force charged with, among other critical tasks, developing a plan to ensure healthcare leaders have access to actionable cyber threat information, through a single source, at no cost.

The healthcare community will further benefit from the establishment of a common set of security and risk management best practices that can be implemented consistently across the sector and mapped to a single, voluntary, national health-specific cybersecurity framework.

As CISA moves forward to a Conference Committee, HIMSS strongly urges the House and Senate to retain these essential provisions so critical to supporting healthcare organizations in more effectively protecting patients and their health information from growing cyber threats.

About HIMSS North America
HIMSS North America, a business unit within HIMSS, positively transforms health and healthcare through the best use of information technology in the United States and Canada. As a cause-based non-profit, HIMSS North America provides thought leadership, community building, professional development, public policy, and events. HIMSS North America represents 61,000 individual members, 640 corporate members, and over 450 non-profit organizations. Thousands of volunteers work with HIMSS to improve the quality, cost-effectiveness, access, and value of healthcare through IT. Major initiatives within HIMSS North America include the HIMSS Annual Conference Exhibition, National Health IT Week, HIMSS Innovation Center, HIMSS Interoperability Showcases™, HIMSS Health IT Value Suite, and ConCert by HIMSS™.

Article source: http://www.himss.org/News/NewsDetail.aspx?ItemNumber=45195

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The Departments of Defense and Veterans Affairs were both admonished on Tuesday for their inability to work together to create a fully interoperable electronic health record system.

The DoD and VA have been attempting to work together for more than two decades to create an interoperable system, and at a Congressional hearing on Tuesday, the House Information Technology Sub-Committee chided technology leaders from each.

“I don’t mean to understate the enormity of the challenge of integrating the two largest federal bureaucracies,” said Rep. William Hurd, R-Texas, chairman of the House Subcommittee on Information Technology during opening statements, “but it’s clear to me that the inability to integrate these two systems is a problem of leadership, rather than technical feasibility.

“We have sent men to the moon and robots to Mars,” he added. “I feel like we should be able to move one electronic file, no matter how big, no matter how old, from one computer system to another.”

The VA cited “persistent internal challenges” and “external pressures” as compelling reasons for change within the department. It also stated its intent to roll out another program to combat interoperability roadblocks.

“This transformation will be different,” said LaVerne Council, assistant secretary for information technology and chief information officer for the VA,” in prepared remarks. “We will measure success, ensure accountability, invest in the capabilities of OIT employees and collaborate across the VA to build trust.”

The VA also noted that it is working closely with the DoD/VA Interagency Program Office and the Office of the National Coordinator for Health Information Technology to ensure coding and data accuracy. However, these facts were not seen by the Congressional Subcommittee on Information Technology.

“The members of our armed forces are still coming home to find that two decades was not long enough for these two departments to get together and develop a workable and fully interoperable EHR,” said Hurd.

“At its core, this is not a problem of technology,” he added. “This is an issue of management.”

The DoD had an equal amount of reasons for a failed interoperable EHR system. Listing the amount of active armed servicemen, civilians and National Guard and Reserve members, David DeVries, Principal Deputy Chief Information Officer for the US DoD, pointed out the enormity of their network and “the $5 billion invested in cybersecurity” as reasons for integration complications, in a prepared statement.

But all of these reasons can’t explain how over $564 million dollars was spent on the failed iEHR attempt between the DoD and VA between October 2011 and June 2013. After which, the branches went their separate ways in terms of EHR development.

The DoD was awarded $4.3 billion to upgrade their Armed Forces Health Longitudinal Technology Application, while the VA is still struggling to modernize their own platform, VistA.

“Missed deadlines, cost overruns and failures to deliver on expectations, leave me with serious doubts about these two departments ability to work towards this common goal,” said Hurd.

The DoD and VA predict a 2022 completion date for their interoperable EHR, long after the 2017 timeframe given while the two organizations were still working together.

While the U.S. Government Accountability Office has noted some small improvements in inter-department connectivity, there is still a long way to go.

Both missed a critical Oct 1, 2014 deadline established in the National Defense Authorization Act for Fiscal Year 2014 that called for compliance with national standards, certify that all health care data in their systems complied with national data standards and were computable in real time, GAO chided.

Moreover, it noted, “the departments do not plan to complete the modernization of their electronic health record systems until well after the December 2016 statutory deadline by which they are to deploy modernized electronic health record software while ensuring full interoperability. Specifically, VA plans to modernize its existing system, while DOD plans to acquire a new system; but their plans indicate that deployment of the new systems with interoperable capabilities will not be complete until after 2018.”

The government’s Interagency Program Office took steps to begin developing metrics to monitor progress related to the standardization of the departments’ data and their exchange of health information, GAO wrote in its report.

For example, it called for the development of tracking metrics to gauge the percentage of data domains within the departments’ current systems that have been mapped to national standards. However, the office had not defined outcome-oriented metrics and related goals to measure the effectiveness of interoperability efforts in terms of improving healthcare services for patients served by both departments.

Article source: http://www.healthcareitnews.com/news/interoperability-years-away-va-dod

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News Release

October 6, 2015

Arlington, VA (October 6,2015) – HIMSS reaffirms its commitment to improving the quality, safety, access, and cost effectiveness of healthcare by achieving widespread secure, electronic exchange of health information. ONC’s Shared Nationwide Interoperability Roadmap is intended to put our Nation on the path to a Learning Health System–where standardized, electronic health information is securely available when needed for patients and providers to engage and drive actionable outcomes.

HIMSS supports the four critical pathways identified in the Roadmap that focus on using consensus-based standards, enabling the shift in payment policies from fee-for-service to value-based models, and aligning federal and state privacy and security requirements that enable interoperability. And we support ONC’s commitments that accompany the Roadmap.

To ensure the right person has the right information about the right patient at the right time, HIMSS’s leadership in interoperability testing, IT certification, and patient data matching remains strong.

Carla Smith, MA, FHIMSS, CNM
Executive Vice President
HIMSS North America

Article source: http://www.himss.org/News/NewsDetail.aspx?ItemNumber=44787

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University of Missouri Health Care is one of the latest two health systems to receive the global HIMSS Enterprise Nicholas E. Davies Award of Excellence for healthcare technology innovations that are improving patient outcomes.

Launched in 1993, the Davies Awards program has promoted electronic health record-enabled improvement in patient outcomes by sharing case studies and lessons learned from a wide range of initiatives.

“At MU Health Care, we know that better health is a journey in which technology plays a bigger role than it ever has before,” Mitch Wasden, CEO and chief operating officer of MU Health Care, said in a press statement. “That’s why we’re committed to using technology to inform and transform how we care for our patients. We’re proud that this commitment has placed MU Health Care among a handful of health systems to earn the prestigious HIMSS Davies Award this year.”

In partnership with the Tiger Institute for Health Innovation, MU Health Care submitted four case studies to demonstrate a robust use of information technology to improve patient care:

  • Case study No. 1 demonstrated a return on investment throughout MU Health Care operations such as medication administration, population health management and emergency department efficiency.
  • Case study No. 2 demonstrated a 25 percent reduction in the number of catheter-associated urinary tract infections at MU Health Care.
  • Case study No. 3 used health information technology to improve communications, minimize delays and streamline the process for operating room starting procedures.
  • Case study No. 4 ensured that data captured by various medical devices was accurately and efficiently integrated into a patient’s electronic medical record.

“Earning a HIMSS Davies Award is no small task,” said Bryan Bliven, chief information officer at MU Health Care and executive director of the Tiger Institute. “Receiving this award validates our emphasis on using and developing information technology solutions to maximize patient care.”

Davies Awards represent the highest level of achievement for electronic medical records excellence that HIMSS offers. The award is open only to organizations that have achieved HIMSS Analytics Stage 6 or Stage 7 designation for advanced electronic medical records. MU Health Care achieved Stage 7 designation in November 2013 for its transition from paper to electronic patient records in outpatient clinics.

MU Health Care has reached several milestones in the adoption of information technology to improve patient care. In July, MU Health Care was recognized for the fifth consecutive year as one of the nation’s “Most Wired” health systems in the 2015 Most Wired Survey by the American Hospital Association.

In February, MU Health Care gave patients the ability to view physician notes online after a visit. The notes include clinical observations, diagnostic test results and other details of a patient’s care, which are automatically synced with the MU Healthe patient portal. The portal is an online secure tool that allows patients to manage appointments, securely message providers, request prescription refills, access immunization history and more.

In August 2014, MU Health Care became the first academic medical center and the ninth health system in the country to meet federal Stage 2 meaningful use.

The othe health system to score an Enterprise Davies Award recognition is Ontario Shores Centre for Mental Health Sciences, a public teaching hospital specializing in comprehensive mental health and addictions services for those with complex, serious and persistent mental illness. The Whitby, Ontario-based system has 15 specialized inpatient units and extensive outpatient and community services.

Ontario Shores conducted a systematic implementation of clinical practice guidelines over a five-year period for the assessment and treatment of patients with schizophrenia, and was able to leverage its EMR to provide real time access to a full spectrum of evidence-based guidelines, increase clinician adherence to clinical best practices and track adherence to practices and provide meaningful feedback to physicians and clinical managers, according to HIMSS.

It was also able to make advances against hospital-acquired infections (mental health care facilities face unique challenges in reducing HAIs due to the large amount of time patients spend in communal areas). Ontario Shores utilizes an Infection Prevention and Control status board supporting an innovative symptom surveillance workflow to identify at-risk patients and initiate precautions in the absence of a physician order. It was able to reduce outbreak days from 47 in the year prior to implementation to seven in the year following implementation.

“Ontario Shores is the first Davies Award Enterprise recipient in the Behavioral Health Space in some time and the first Canadian hospital to receive this award,” said Jonathan French, director of health information systems at HIMSS and program director of the HIMSS Davies Enterprise Committee. “Ontario Shores has leveraged technology to ensure their patients receive the correct treatment and care at the correct time. They have reduced medication errors and infections that threaten the health of their patients, while improving their quality of life through improved mental health.

“The replicable workflows they have developed that intertwine real time data delivered by the EMR directly into care delivery are an outstanding example for behavioral health facilities looking to improve care delivery through the use of technology,” he added. The Davies Committee and HIMSS congratulate the team members of Ontario Shores on improving the outcomes of their patient population through the effective use of health IT.”

Both health systems will be honored at the 2016 Annual HIMSS Conference Exhibition, Feb. 29 to March 4, 2016, in Las Vegas.

Article source: http://www.healthcareitnews.com/news/mus-it-work-lands-davies-award

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