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Official Newspaper of the American College of Surgeons
Coalition decries legislative interference in medicine
A coalition of physician, consumer, and other advocacy groups is asking politicians to stop trying to regulate the physician-patient relationship.
The Coalition to Protect the Patient-Provider Relationship – which includes the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American College of Physicians, and 13 other organizations – issued a statement expressing “serious concern” about the increasing number of government actions that “inappropriately interfere” in the relationship between patients and their health care providers by asking providers to violate their medical training and their ethical obligations to patients.
The statement points to laws recently enacted in Arizona and Arkansas that require abortion providers to inform patients that medication abortion may be reversible, a claim that is not supported by science, the coalition wrote.
“The mandate is emblematic of a larger trend of lawmakers abusing their responsibilities by imposing ideological views on licensed and highly trained health care professionals,” the coalition said in its statement.
The coalition urged lawmakers to follow four principles to protect the patient-provider relationship:
The coalition’s statement comes as physician organizations are increasingly pushing back against lawmakers for attempts to legislate their interactions with patients, including a Florida law that bars physicians from asking families about the presence of guns in the home and requirements in other states that women have ultrasonography before an abortion.
In 2012, the ACP, AAFP, ACOG, American Academy of Pediatrics, and American College of Surgeons wrote a joint editorial in the New England Journal of Medicine condemning these laws (2012;367:1557-9).
“Physicians must have the ability and freedom to speak to their patients freely and confidentially, to provide patients with factual information relevant to their health, to fully answer their patients’ questions, and to advise them on the course of best care without the fear of penalty,” the groups wrote in the editorial.
On Twitter @maryellenny
A coalition of physician, consumer, and other advocacy groups is asking politicians to stop trying to regulate the physician-patient relationship.
The Coalition to Protect the Patient-Provider Relationship – which includes the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American College of Physicians, and 13 other organizations – issued a statement expressing “serious concern” about the increasing number of government actions that “inappropriately interfere” in the relationship between patients and their health care providers by asking providers to violate their medical training and their ethical obligations to patients.
The statement points to laws recently enacted in Arizona and Arkansas that require abortion providers to inform patients that medication abortion may be reversible, a claim that is not supported by science, the coalition wrote.
“The mandate is emblematic of a larger trend of lawmakers abusing their responsibilities by imposing ideological views on licensed and highly trained health care professionals,” the coalition said in its statement.
The coalition urged lawmakers to follow four principles to protect the patient-provider relationship:
The coalition’s statement comes as physician organizations are increasingly pushing back against lawmakers for attempts to legislate their interactions with patients, including a Florida law that bars physicians from asking families about the presence of guns in the home and requirements in other states that women have ultrasonography before an abortion.
In 2012, the ACP, AAFP, ACOG, American Academy of Pediatrics, and American College of Surgeons wrote a joint editorial in the New England Journal of Medicine condemning these laws (2012;367:1557-9).
“Physicians must have the ability and freedom to speak to their patients freely and confidentially, to provide patients with factual information relevant to their health, to fully answer their patients’ questions, and to advise them on the course of best care without the fear of penalty,” the groups wrote in the editorial.
On Twitter @maryellenny
A coalition of physician, consumer, and other advocacy groups is asking politicians to stop trying to regulate the physician-patient relationship.
The Coalition to Protect the Patient-Provider Relationship – which includes the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American College of Physicians, and 13 other organizations – issued a statement expressing “serious concern” about the increasing number of government actions that “inappropriately interfere” in the relationship between patients and their health care providers by asking providers to violate their medical training and their ethical obligations to patients.
The statement points to laws recently enacted in Arizona and Arkansas that require abortion providers to inform patients that medication abortion may be reversible, a claim that is not supported by science, the coalition wrote.
“The mandate is emblematic of a larger trend of lawmakers abusing their responsibilities by imposing ideological views on licensed and highly trained health care professionals,” the coalition said in its statement.
The coalition urged lawmakers to follow four principles to protect the patient-provider relationship:
The coalition’s statement comes as physician organizations are increasingly pushing back against lawmakers for attempts to legislate their interactions with patients, including a Florida law that bars physicians from asking families about the presence of guns in the home and requirements in other states that women have ultrasonography before an abortion.
In 2012, the ACP, AAFP, ACOG, American Academy of Pediatrics, and American College of Surgeons wrote a joint editorial in the New England Journal of Medicine condemning these laws (2012;367:1557-9).
“Physicians must have the ability and freedom to speak to their patients freely and confidentially, to provide patients with factual information relevant to their health, to fully answer their patients’ questions, and to advise them on the course of best care without the fear of penalty,” the groups wrote in the editorial.
On Twitter @maryellenny
Cyber thieves exploiting health care security gaps
CHICAGO – Health care data theft represents a far greater threat than theft of credit card, financial, and banking information.
The reasons are simple: stolen health care records have a longer shelf life and offer a higher payout on the black market, James Trainor, deputy assistant director of the Federal Bureau of Investigation’s Cyber Division, said at the annual meeting of the Healthcare Information Management Systems Society.
When credit cards are stolen it’s pretty easy to identify the information on cyber crime forums and compensate for loss, so the value of that stolen credit card or bank record has a certain shelf life. For health care records, it’s harder to identify where those stolen records may end up and as such it creates a greater challenge for law enforcement.
The opportunity to exploit and monetize stolen health care data for various forms of fraud such as identity, Medicaid, tax, medical device, and pharmaceutical fraud increases the value at which they can be sold online.
“Actually, it’s one of the primary reasons why criminal organizations go after health care records,” Mr. Trainor said.
Not surprisingly, the FBI rates health care data theft as a Tier 1 priority, capable of causing “catastrophic or severe harm.”
And the problem is growing. Two years ago, a significant cyber intrusion occurred every 2 weeks; now it happens every 2-3 days.
“The pace is growing rapidly, the volume of data that’s being [stolen] is substantially increasing, and it just requires a much more robust response across the U.S. government and private sector,” said Mr. Trainor, who helped investigate the December 2014 Sony cyber attack.
Some of the unique challenges to the health care sector are the use of legacy computer systems, “bring your own device” policies, and increased volume of data following the transition to electronic health records, and stolen protected health information isn’t readily discovered, he said. The range, size, and capability of IT infrastructure varies dramatically as do the funding and resources needed to keep up with the rapidly changing IT field.
Other challenges include video conferencing systems, digital video systems used for consultations and remote procedures, and Internet-connected medical devices such as insulin pumps, pacemakers, and MRI machines, said Kevin Hemsley, a project manager at the Idaho National Laboratory supporting the Department of Homeland Security’s Industrial Control Systems Computer Emergency Response Team.
While providers love the ability to use the Internet to control and monitor devices, ingrained security mechanisms can be minimal. This makes for low-hanging fruit for thieves who can enter the system and even lock up an otherwise safe device.
Mr. Hemsley noted that a 2014 report by the Internet security and training firm SANS found that 33% of malicious traffic passed through or was transmitted from VPN applications and devices versus 16% from firewalls, 7% from routers, and 3% from enterprise network controllers.
“One of the messages here is to look at cyber security as being more than HIPPA, it’s patient safety,” he said.
Both experts advised physicians and other health care providers to update their privacy and security software frequently. Available resources include the FBI’s 24-hour CyWatch (855-292-3937/[email protected]), Cyber Task Force (with 56 local field offices), and for individuals, the Internet Crime Complaint Center (www.ic3.gov).
Speedy communication with officials following a data breech is important not just to get the institution’s system back up and running, but it allows officials to identify data footprints left by hackers before they are destroyed, Mr. Trainor said.
In two of the three recent high profile health care cyber attacks involving Community Health Systems (4.5 million accounts), Anthem Blue Cross Blue Shield (78 million records), and Premera Blue Cross (11 million consumers), the institutions contacted the FBI, but in one unnamed case, the FBI had to make the call, he pointed out.
CHICAGO – Health care data theft represents a far greater threat than theft of credit card, financial, and banking information.
The reasons are simple: stolen health care records have a longer shelf life and offer a higher payout on the black market, James Trainor, deputy assistant director of the Federal Bureau of Investigation’s Cyber Division, said at the annual meeting of the Healthcare Information Management Systems Society.
When credit cards are stolen it’s pretty easy to identify the information on cyber crime forums and compensate for loss, so the value of that stolen credit card or bank record has a certain shelf life. For health care records, it’s harder to identify where those stolen records may end up and as such it creates a greater challenge for law enforcement.
The opportunity to exploit and monetize stolen health care data for various forms of fraud such as identity, Medicaid, tax, medical device, and pharmaceutical fraud increases the value at which they can be sold online.
“Actually, it’s one of the primary reasons why criminal organizations go after health care records,” Mr. Trainor said.
Not surprisingly, the FBI rates health care data theft as a Tier 1 priority, capable of causing “catastrophic or severe harm.”
And the problem is growing. Two years ago, a significant cyber intrusion occurred every 2 weeks; now it happens every 2-3 days.
“The pace is growing rapidly, the volume of data that’s being [stolen] is substantially increasing, and it just requires a much more robust response across the U.S. government and private sector,” said Mr. Trainor, who helped investigate the December 2014 Sony cyber attack.
Some of the unique challenges to the health care sector are the use of legacy computer systems, “bring your own device” policies, and increased volume of data following the transition to electronic health records, and stolen protected health information isn’t readily discovered, he said. The range, size, and capability of IT infrastructure varies dramatically as do the funding and resources needed to keep up with the rapidly changing IT field.
Other challenges include video conferencing systems, digital video systems used for consultations and remote procedures, and Internet-connected medical devices such as insulin pumps, pacemakers, and MRI machines, said Kevin Hemsley, a project manager at the Idaho National Laboratory supporting the Department of Homeland Security’s Industrial Control Systems Computer Emergency Response Team.
While providers love the ability to use the Internet to control and monitor devices, ingrained security mechanisms can be minimal. This makes for low-hanging fruit for thieves who can enter the system and even lock up an otherwise safe device.
Mr. Hemsley noted that a 2014 report by the Internet security and training firm SANS found that 33% of malicious traffic passed through or was transmitted from VPN applications and devices versus 16% from firewalls, 7% from routers, and 3% from enterprise network controllers.
“One of the messages here is to look at cyber security as being more than HIPPA, it’s patient safety,” he said.
Both experts advised physicians and other health care providers to update their privacy and security software frequently. Available resources include the FBI’s 24-hour CyWatch (855-292-3937/[email protected]), Cyber Task Force (with 56 local field offices), and for individuals, the Internet Crime Complaint Center (www.ic3.gov).
Speedy communication with officials following a data breech is important not just to get the institution’s system back up and running, but it allows officials to identify data footprints left by hackers before they are destroyed, Mr. Trainor said.
In two of the three recent high profile health care cyber attacks involving Community Health Systems (4.5 million accounts), Anthem Blue Cross Blue Shield (78 million records), and Premera Blue Cross (11 million consumers), the institutions contacted the FBI, but in one unnamed case, the FBI had to make the call, he pointed out.
CHICAGO – Health care data theft represents a far greater threat than theft of credit card, financial, and banking information.
The reasons are simple: stolen health care records have a longer shelf life and offer a higher payout on the black market, James Trainor, deputy assistant director of the Federal Bureau of Investigation’s Cyber Division, said at the annual meeting of the Healthcare Information Management Systems Society.
When credit cards are stolen it’s pretty easy to identify the information on cyber crime forums and compensate for loss, so the value of that stolen credit card or bank record has a certain shelf life. For health care records, it’s harder to identify where those stolen records may end up and as such it creates a greater challenge for law enforcement.
The opportunity to exploit and monetize stolen health care data for various forms of fraud such as identity, Medicaid, tax, medical device, and pharmaceutical fraud increases the value at which they can be sold online.
“Actually, it’s one of the primary reasons why criminal organizations go after health care records,” Mr. Trainor said.
Not surprisingly, the FBI rates health care data theft as a Tier 1 priority, capable of causing “catastrophic or severe harm.”
And the problem is growing. Two years ago, a significant cyber intrusion occurred every 2 weeks; now it happens every 2-3 days.
“The pace is growing rapidly, the volume of data that’s being [stolen] is substantially increasing, and it just requires a much more robust response across the U.S. government and private sector,” said Mr. Trainor, who helped investigate the December 2014 Sony cyber attack.
Some of the unique challenges to the health care sector are the use of legacy computer systems, “bring your own device” policies, and increased volume of data following the transition to electronic health records, and stolen protected health information isn’t readily discovered, he said. The range, size, and capability of IT infrastructure varies dramatically as do the funding and resources needed to keep up with the rapidly changing IT field.
Other challenges include video conferencing systems, digital video systems used for consultations and remote procedures, and Internet-connected medical devices such as insulin pumps, pacemakers, and MRI machines, said Kevin Hemsley, a project manager at the Idaho National Laboratory supporting the Department of Homeland Security’s Industrial Control Systems Computer Emergency Response Team.
While providers love the ability to use the Internet to control and monitor devices, ingrained security mechanisms can be minimal. This makes for low-hanging fruit for thieves who can enter the system and even lock up an otherwise safe device.
Mr. Hemsley noted that a 2014 report by the Internet security and training firm SANS found that 33% of malicious traffic passed through or was transmitted from VPN applications and devices versus 16% from firewalls, 7% from routers, and 3% from enterprise network controllers.
“One of the messages here is to look at cyber security as being more than HIPPA, it’s patient safety,” he said.
Both experts advised physicians and other health care providers to update their privacy and security software frequently. Available resources include the FBI’s 24-hour CyWatch (855-292-3937/[email protected]), Cyber Task Force (with 56 local field offices), and for individuals, the Internet Crime Complaint Center (www.ic3.gov).
Speedy communication with officials following a data breech is important not just to get the institution’s system back up and running, but it allows officials to identify data footprints left by hackers before they are destroyed, Mr. Trainor said.
In two of the three recent high profile health care cyber attacks involving Community Health Systems (4.5 million accounts), Anthem Blue Cross Blue Shield (78 million records), and Premera Blue Cross (11 million consumers), the institutions contacted the FBI, but in one unnamed case, the FBI had to make the call, he pointed out.
EXPERT ANALYSIS FROM HIMSS15
Power morcellation debate: Crunching the data
ORLANDO – Independent of the objective data, the top hits for a Google search of power morcellation are advertisements from lawyers seeking malpractice clients, observed one of four experts participating in a debate at the annual scientific meeting of the Society of Gynecologic Surgeons.
In this opening salvo for the con position, Dr. Eric R. Sokol, an ob.gyn. and urogynecologist at Stanford (Calif.) University, acknowledged, “I am going to appeal a little bit more to your emotions to start.”
The emotional appeal may have resonated. Despite compelling data provided by those providing the pro position, a loose poll at the meeting suggested that only a handful of gynecologic surgeons in the audience still consider power morcellation a viable routine tool for the removal of fibroids.
Use of power morcellation of fibroids has been challenged on the basis of evidence that it is capable of spreading cancerous tissue if used in a woman with unsuspected uterine sarcoma. After convening a panel of experts, the Food and Drug Administration issued a safety communication April 17, 2014 that officially “discourages” use of this device for uterine fibroids.
However, not all experts accept the position that this device should be discouraged in all patients, including one of those who addressed the FDA panel and provided the pro position in the SGS debate. Dr. Jubilee Brown, an ob.gyn. in the department of gynecologic oncology and reproductive medicine at the University of Texas M.D. Anderson Cancer Center, Houston, outlined how a benefit-to-risk analysis still favors power morcellation in at least some individuals.
“We should improve but not abandon power morcellation,” Dr. Brown said. “Power morcellation with appropriate informed consent should remain available to appropriately screened, low-risk women.”
Dr. Brown based this position largely on two decision analyses that show minimally invasive laparoscopic hysterectomy with power morcellation of fibroids is safer than an open abdominal approach, which is the most commonly used alternative. One analysis by Dr. Matthew T. Siedhoff and his associates has been recently published (Am. J. Obstet. Gynecol. 2015 [doi:10.1016/j.ajog.2015.03.006]) while the other, for which Dr. Brown is an author, is in press.
The bottom line for both was that minimally invasive hysterectomy with power morcellation would produce a lower mortality rate than abdominal laparotomy when considering all the risks for both. Specifically, the open, abdominal approach is associated with more fatal surgery-related complications, compensating for the greater but rare risk of cancer-related deaths associated with power morcellation.
To establish true benefit-to-risk equations, Dr. Brown argued that it is essential to rely on objective data. The risks posed by power morcellation for spreading cancer have “been sensationalized in the media” without fully considering how rare these cancers are. In her reading of the published data, 1 case occurs in every 452 patients to 6,400 patients.
“No one is going to argue that this [power morcellation] is a no-risk procedure,“ Dr. Brown observed, but she maintained it is important to consider this risk in context, which includes the complications associated with alternative approaches.
As a participant on the con side, Dr. Sokol rebutted with some data of his own, including a worst-case estimate that suggests the case rate of uterine sarcomas among candidates for hysterectomy may be as high as 1 in 352. However, he suggested that arguing about case rates may not be the critical issue. Rather, other risks of power morcellation deserve consideration.
“We frame this debate about the risk of sarcoma, but I think there are a lot of other issues surrounding morcellation that are important, including the risk of spreading benign disease,” Dr. Sokol maintained at the meeting jointly sponsored by the American College of Surgeons.
Citing a published analysis of a large insurance database with 36,470 women who underwent morcellation (JAMA 2014;312:1253-5), Dr. Sokol noted that the proportion of patients with pathology climbs markedly when it includes those with findings in addition to sarcoma. Specifically, while the case rate of uterine cancer was 2.7 per 1,000 patients, there were an additional 0.7 cases of gynecologic cancers of other types, 1.1 cases of uterine neoplasms with uncertain malignant potential, and 10 cases of endometrial hyperplasia.
“The prevalence of malignancy was 0.34%, but the prevalence of neoplastic conditions was 1.5%, and that is a pretty significant number,” he observed.
Beyond these data, Dr. Sokol focused on conceptual risks. As an example, he proposed that most clinicians would hesitate to employ a morcellator on tissue that appeared infected, and he suggested that this hesitation should apply in tissue with an unknown risk of neoplastic transformation.
“Cancer can spread much like an infection,” he maintained. “Why would you treat uterine fibroids or other masses that could be cancerous differently [than you would an infection]?”
One answer might be to reduce the risk of morcellated tissue from being disseminated in the peritoneal cavity, according to Dr. Andrew Sokol, an ob.gyn. and urologist at Georgetown University, Washington. The brother of Dr. Eric Sokol and serving on the pro side of the debate, Dr. Sokol suggested that containment bag attachments are being developed for power morcellator devices, and these appear to preserve the benefits while mitigating the risks.
Citing some early data from controlled studies indicating that surgical outcomes using containment bags are similar to those without a bag, Dr. Sokol suggested that containment bags might be the way to improve rather than abandon power morcellation.
Despite the potential risk of rupture and the need for more data, “these bags have the potential to maintain the advantages of minimally invasive surgery,” said Dr. Sokol, although he acknowledged that no containment bags have been approved by the FDA.
The final panelist in the debate rejected both minimally invasive surgery with power morcellation and open abdominal hysterectomies as a first choice in most women. Rather, Dr. Carl Zimmerman, professor of obstetrics and gynecology at Vanderbilt University Medical Center, Nashville, Tenn., maintained hysterectomies should most often be performed vaginally and morcellation of the fibroid should be performed extracorporeally.
“I was unable to find a single report of spread of malignant tumor” when morcellation of the fibroid was performed outside the body after a vaginal hysterectomy, Dr. Zimmerman reported. He expressed dismay that employing vaginal surgery has not been much discussed in any of the statements guiding clinicians to alternatives for power morcellation.
One reason vaginal hysterectomy is being overlooked, according to Dr. Zimmerman, is a decline in training for this technique. He believes that surgeons should either learn to perform vaginal hysterectomies or be prepared to refer patients to those experienced with this procedure.
“What do we need to do as surgeons? We need to have a working knowledge of all the surgical approaches to a given problem, and then we are ethically obligated to help our patients to chose the correct one in terms of safety, cost, and recovery,” Dr. Zimmerman said. For many women with fibroids, he believes the correct choice would be a vaginal hysterectomy that avoids both morcellation in the peritoneal space and the disadvantages of an open approach.
The debate was initially framed by a case. In the description, a 44-year-old woman with menorrhagia and fibroids had multiple features suggesting a low risk of uterine sarcoma, including a recent biopsy of the endometrium that proved benign. In this case, Dr. Brown described minimally invasive surgery with power morcellation as an “excellent option,” while Dr. Eric Sokol maintained the FDA advisory remained applicable.
However, for the minority of surgeons in the audience who sided with Dr. Brown, one issue may be reimbursement. Ten days after the SGS debate, a survey conducted by and published in the Wall Street Journal (April 3, 2015) found that insurance companies covering more than 90 million Americans have established or are considering restrictions on reimbursement for power morcellation. Increasingly, the choice is being taken out of the hands of both surgeons and patients.
Dr. Jubilee Brown, Dr. Andrew Sokol, Dr. Eric Sokol, and Dr. Carl Zimmerman reported no relevant financial disclosures.
ORLANDO – Independent of the objective data, the top hits for a Google search of power morcellation are advertisements from lawyers seeking malpractice clients, observed one of four experts participating in a debate at the annual scientific meeting of the Society of Gynecologic Surgeons.
In this opening salvo for the con position, Dr. Eric R. Sokol, an ob.gyn. and urogynecologist at Stanford (Calif.) University, acknowledged, “I am going to appeal a little bit more to your emotions to start.”
The emotional appeal may have resonated. Despite compelling data provided by those providing the pro position, a loose poll at the meeting suggested that only a handful of gynecologic surgeons in the audience still consider power morcellation a viable routine tool for the removal of fibroids.
Use of power morcellation of fibroids has been challenged on the basis of evidence that it is capable of spreading cancerous tissue if used in a woman with unsuspected uterine sarcoma. After convening a panel of experts, the Food and Drug Administration issued a safety communication April 17, 2014 that officially “discourages” use of this device for uterine fibroids.
However, not all experts accept the position that this device should be discouraged in all patients, including one of those who addressed the FDA panel and provided the pro position in the SGS debate. Dr. Jubilee Brown, an ob.gyn. in the department of gynecologic oncology and reproductive medicine at the University of Texas M.D. Anderson Cancer Center, Houston, outlined how a benefit-to-risk analysis still favors power morcellation in at least some individuals.
“We should improve but not abandon power morcellation,” Dr. Brown said. “Power morcellation with appropriate informed consent should remain available to appropriately screened, low-risk women.”
Dr. Brown based this position largely on two decision analyses that show minimally invasive laparoscopic hysterectomy with power morcellation of fibroids is safer than an open abdominal approach, which is the most commonly used alternative. One analysis by Dr. Matthew T. Siedhoff and his associates has been recently published (Am. J. Obstet. Gynecol. 2015 [doi:10.1016/j.ajog.2015.03.006]) while the other, for which Dr. Brown is an author, is in press.
The bottom line for both was that minimally invasive hysterectomy with power morcellation would produce a lower mortality rate than abdominal laparotomy when considering all the risks for both. Specifically, the open, abdominal approach is associated with more fatal surgery-related complications, compensating for the greater but rare risk of cancer-related deaths associated with power morcellation.
To establish true benefit-to-risk equations, Dr. Brown argued that it is essential to rely on objective data. The risks posed by power morcellation for spreading cancer have “been sensationalized in the media” without fully considering how rare these cancers are. In her reading of the published data, 1 case occurs in every 452 patients to 6,400 patients.
“No one is going to argue that this [power morcellation] is a no-risk procedure,“ Dr. Brown observed, but she maintained it is important to consider this risk in context, which includes the complications associated with alternative approaches.
As a participant on the con side, Dr. Sokol rebutted with some data of his own, including a worst-case estimate that suggests the case rate of uterine sarcomas among candidates for hysterectomy may be as high as 1 in 352. However, he suggested that arguing about case rates may not be the critical issue. Rather, other risks of power morcellation deserve consideration.
“We frame this debate about the risk of sarcoma, but I think there are a lot of other issues surrounding morcellation that are important, including the risk of spreading benign disease,” Dr. Sokol maintained at the meeting jointly sponsored by the American College of Surgeons.
Citing a published analysis of a large insurance database with 36,470 women who underwent morcellation (JAMA 2014;312:1253-5), Dr. Sokol noted that the proportion of patients with pathology climbs markedly when it includes those with findings in addition to sarcoma. Specifically, while the case rate of uterine cancer was 2.7 per 1,000 patients, there were an additional 0.7 cases of gynecologic cancers of other types, 1.1 cases of uterine neoplasms with uncertain malignant potential, and 10 cases of endometrial hyperplasia.
“The prevalence of malignancy was 0.34%, but the prevalence of neoplastic conditions was 1.5%, and that is a pretty significant number,” he observed.
Beyond these data, Dr. Sokol focused on conceptual risks. As an example, he proposed that most clinicians would hesitate to employ a morcellator on tissue that appeared infected, and he suggested that this hesitation should apply in tissue with an unknown risk of neoplastic transformation.
“Cancer can spread much like an infection,” he maintained. “Why would you treat uterine fibroids or other masses that could be cancerous differently [than you would an infection]?”
One answer might be to reduce the risk of morcellated tissue from being disseminated in the peritoneal cavity, according to Dr. Andrew Sokol, an ob.gyn. and urologist at Georgetown University, Washington. The brother of Dr. Eric Sokol and serving on the pro side of the debate, Dr. Sokol suggested that containment bag attachments are being developed for power morcellator devices, and these appear to preserve the benefits while mitigating the risks.
Citing some early data from controlled studies indicating that surgical outcomes using containment bags are similar to those without a bag, Dr. Sokol suggested that containment bags might be the way to improve rather than abandon power morcellation.
Despite the potential risk of rupture and the need for more data, “these bags have the potential to maintain the advantages of minimally invasive surgery,” said Dr. Sokol, although he acknowledged that no containment bags have been approved by the FDA.
The final panelist in the debate rejected both minimally invasive surgery with power morcellation and open abdominal hysterectomies as a first choice in most women. Rather, Dr. Carl Zimmerman, professor of obstetrics and gynecology at Vanderbilt University Medical Center, Nashville, Tenn., maintained hysterectomies should most often be performed vaginally and morcellation of the fibroid should be performed extracorporeally.
“I was unable to find a single report of spread of malignant tumor” when morcellation of the fibroid was performed outside the body after a vaginal hysterectomy, Dr. Zimmerman reported. He expressed dismay that employing vaginal surgery has not been much discussed in any of the statements guiding clinicians to alternatives for power morcellation.
One reason vaginal hysterectomy is being overlooked, according to Dr. Zimmerman, is a decline in training for this technique. He believes that surgeons should either learn to perform vaginal hysterectomies or be prepared to refer patients to those experienced with this procedure.
“What do we need to do as surgeons? We need to have a working knowledge of all the surgical approaches to a given problem, and then we are ethically obligated to help our patients to chose the correct one in terms of safety, cost, and recovery,” Dr. Zimmerman said. For many women with fibroids, he believes the correct choice would be a vaginal hysterectomy that avoids both morcellation in the peritoneal space and the disadvantages of an open approach.
The debate was initially framed by a case. In the description, a 44-year-old woman with menorrhagia and fibroids had multiple features suggesting a low risk of uterine sarcoma, including a recent biopsy of the endometrium that proved benign. In this case, Dr. Brown described minimally invasive surgery with power morcellation as an “excellent option,” while Dr. Eric Sokol maintained the FDA advisory remained applicable.
However, for the minority of surgeons in the audience who sided with Dr. Brown, one issue may be reimbursement. Ten days after the SGS debate, a survey conducted by and published in the Wall Street Journal (April 3, 2015) found that insurance companies covering more than 90 million Americans have established or are considering restrictions on reimbursement for power morcellation. Increasingly, the choice is being taken out of the hands of both surgeons and patients.
Dr. Jubilee Brown, Dr. Andrew Sokol, Dr. Eric Sokol, and Dr. Carl Zimmerman reported no relevant financial disclosures.
ORLANDO – Independent of the objective data, the top hits for a Google search of power morcellation are advertisements from lawyers seeking malpractice clients, observed one of four experts participating in a debate at the annual scientific meeting of the Society of Gynecologic Surgeons.
In this opening salvo for the con position, Dr. Eric R. Sokol, an ob.gyn. and urogynecologist at Stanford (Calif.) University, acknowledged, “I am going to appeal a little bit more to your emotions to start.”
The emotional appeal may have resonated. Despite compelling data provided by those providing the pro position, a loose poll at the meeting suggested that only a handful of gynecologic surgeons in the audience still consider power morcellation a viable routine tool for the removal of fibroids.
Use of power morcellation of fibroids has been challenged on the basis of evidence that it is capable of spreading cancerous tissue if used in a woman with unsuspected uterine sarcoma. After convening a panel of experts, the Food and Drug Administration issued a safety communication April 17, 2014 that officially “discourages” use of this device for uterine fibroids.
However, not all experts accept the position that this device should be discouraged in all patients, including one of those who addressed the FDA panel and provided the pro position in the SGS debate. Dr. Jubilee Brown, an ob.gyn. in the department of gynecologic oncology and reproductive medicine at the University of Texas M.D. Anderson Cancer Center, Houston, outlined how a benefit-to-risk analysis still favors power morcellation in at least some individuals.
“We should improve but not abandon power morcellation,” Dr. Brown said. “Power morcellation with appropriate informed consent should remain available to appropriately screened, low-risk women.”
Dr. Brown based this position largely on two decision analyses that show minimally invasive laparoscopic hysterectomy with power morcellation of fibroids is safer than an open abdominal approach, which is the most commonly used alternative. One analysis by Dr. Matthew T. Siedhoff and his associates has been recently published (Am. J. Obstet. Gynecol. 2015 [doi:10.1016/j.ajog.2015.03.006]) while the other, for which Dr. Brown is an author, is in press.
The bottom line for both was that minimally invasive hysterectomy with power morcellation would produce a lower mortality rate than abdominal laparotomy when considering all the risks for both. Specifically, the open, abdominal approach is associated with more fatal surgery-related complications, compensating for the greater but rare risk of cancer-related deaths associated with power morcellation.
To establish true benefit-to-risk equations, Dr. Brown argued that it is essential to rely on objective data. The risks posed by power morcellation for spreading cancer have “been sensationalized in the media” without fully considering how rare these cancers are. In her reading of the published data, 1 case occurs in every 452 patients to 6,400 patients.
“No one is going to argue that this [power morcellation] is a no-risk procedure,“ Dr. Brown observed, but she maintained it is important to consider this risk in context, which includes the complications associated with alternative approaches.
As a participant on the con side, Dr. Sokol rebutted with some data of his own, including a worst-case estimate that suggests the case rate of uterine sarcomas among candidates for hysterectomy may be as high as 1 in 352. However, he suggested that arguing about case rates may not be the critical issue. Rather, other risks of power morcellation deserve consideration.
“We frame this debate about the risk of sarcoma, but I think there are a lot of other issues surrounding morcellation that are important, including the risk of spreading benign disease,” Dr. Sokol maintained at the meeting jointly sponsored by the American College of Surgeons.
Citing a published analysis of a large insurance database with 36,470 women who underwent morcellation (JAMA 2014;312:1253-5), Dr. Sokol noted that the proportion of patients with pathology climbs markedly when it includes those with findings in addition to sarcoma. Specifically, while the case rate of uterine cancer was 2.7 per 1,000 patients, there were an additional 0.7 cases of gynecologic cancers of other types, 1.1 cases of uterine neoplasms with uncertain malignant potential, and 10 cases of endometrial hyperplasia.
“The prevalence of malignancy was 0.34%, but the prevalence of neoplastic conditions was 1.5%, and that is a pretty significant number,” he observed.
Beyond these data, Dr. Sokol focused on conceptual risks. As an example, he proposed that most clinicians would hesitate to employ a morcellator on tissue that appeared infected, and he suggested that this hesitation should apply in tissue with an unknown risk of neoplastic transformation.
“Cancer can spread much like an infection,” he maintained. “Why would you treat uterine fibroids or other masses that could be cancerous differently [than you would an infection]?”
One answer might be to reduce the risk of morcellated tissue from being disseminated in the peritoneal cavity, according to Dr. Andrew Sokol, an ob.gyn. and urologist at Georgetown University, Washington. The brother of Dr. Eric Sokol and serving on the pro side of the debate, Dr. Sokol suggested that containment bag attachments are being developed for power morcellator devices, and these appear to preserve the benefits while mitigating the risks.
Citing some early data from controlled studies indicating that surgical outcomes using containment bags are similar to those without a bag, Dr. Sokol suggested that containment bags might be the way to improve rather than abandon power morcellation.
Despite the potential risk of rupture and the need for more data, “these bags have the potential to maintain the advantages of minimally invasive surgery,” said Dr. Sokol, although he acknowledged that no containment bags have been approved by the FDA.
The final panelist in the debate rejected both minimally invasive surgery with power morcellation and open abdominal hysterectomies as a first choice in most women. Rather, Dr. Carl Zimmerman, professor of obstetrics and gynecology at Vanderbilt University Medical Center, Nashville, Tenn., maintained hysterectomies should most often be performed vaginally and morcellation of the fibroid should be performed extracorporeally.
“I was unable to find a single report of spread of malignant tumor” when morcellation of the fibroid was performed outside the body after a vaginal hysterectomy, Dr. Zimmerman reported. He expressed dismay that employing vaginal surgery has not been much discussed in any of the statements guiding clinicians to alternatives for power morcellation.
One reason vaginal hysterectomy is being overlooked, according to Dr. Zimmerman, is a decline in training for this technique. He believes that surgeons should either learn to perform vaginal hysterectomies or be prepared to refer patients to those experienced with this procedure.
“What do we need to do as surgeons? We need to have a working knowledge of all the surgical approaches to a given problem, and then we are ethically obligated to help our patients to chose the correct one in terms of safety, cost, and recovery,” Dr. Zimmerman said. For many women with fibroids, he believes the correct choice would be a vaginal hysterectomy that avoids both morcellation in the peritoneal space and the disadvantages of an open approach.
The debate was initially framed by a case. In the description, a 44-year-old woman with menorrhagia and fibroids had multiple features suggesting a low risk of uterine sarcoma, including a recent biopsy of the endometrium that proved benign. In this case, Dr. Brown described minimally invasive surgery with power morcellation as an “excellent option,” while Dr. Eric Sokol maintained the FDA advisory remained applicable.
However, for the minority of surgeons in the audience who sided with Dr. Brown, one issue may be reimbursement. Ten days after the SGS debate, a survey conducted by and published in the Wall Street Journal (April 3, 2015) found that insurance companies covering more than 90 million Americans have established or are considering restrictions on reimbursement for power morcellation. Increasingly, the choice is being taken out of the hands of both surgeons and patients.
Dr. Jubilee Brown, Dr. Andrew Sokol, Dr. Eric Sokol, and Dr. Carl Zimmerman reported no relevant financial disclosures.
CMS: A few claims were processed at 21% SGR cut level
A small volume of Medicare claims were processed at the 21% pay cut level mandated by the Sustainable Growth Rate formula, according to a provider advisory issued April 15 by the Centers for Medicare & Medicaid Services.
Claims were processed April 15 by Medicare Administrative Contractors as the CMS guidance to hold for 10 business days claims submitted beginning April 1 expired.
The claims will be reprocessed automatically at the higher rate, CMS officials said.
The House and Senate have both passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which permanently repeals the SGR, among many other provisions. President Obama has indicated he will sign the legislation.
On Twitter @denisefulton
A small volume of Medicare claims were processed at the 21% pay cut level mandated by the Sustainable Growth Rate formula, according to a provider advisory issued April 15 by the Centers for Medicare & Medicaid Services.
Claims were processed April 15 by Medicare Administrative Contractors as the CMS guidance to hold for 10 business days claims submitted beginning April 1 expired.
The claims will be reprocessed automatically at the higher rate, CMS officials said.
The House and Senate have both passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which permanently repeals the SGR, among many other provisions. President Obama has indicated he will sign the legislation.
On Twitter @denisefulton
A small volume of Medicare claims were processed at the 21% pay cut level mandated by the Sustainable Growth Rate formula, according to a provider advisory issued April 15 by the Centers for Medicare & Medicaid Services.
Claims were processed April 15 by Medicare Administrative Contractors as the CMS guidance to hold for 10 business days claims submitted beginning April 1 expired.
The claims will be reprocessed automatically at the higher rate, CMS officials said.
The House and Senate have both passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which permanently repeals the SGR, among many other provisions. President Obama has indicated he will sign the legislation.
On Twitter @denisefulton
Commercial board-review courses offer no bang for the buck
CHICAGO – A national survey of 1,246 residents found no evidence that taking a commercial board-review course provides any benefit in passing the American Board of Surgery certifying exam.
And none of the courses was significantly better than another, reported Dr. Mark Malangoni, an ACS Fellow and ABS associate executive director.
“Exam-review courses are now a multibillion-dollar industry … but there is little evidence to suggest they actually improve exam performance,” he said.
Dr. Malangoni and his ABS colleagues electronically surveyed 1,396 candidates who took the ABS certifying exam (CE) during the 2012-2013 academic year. Of the 1,246 who responded, 974 (78%) had taken a review course. Another 140 candidates declined to respond to the two-question survey, but their CE test results were available for comparison.
Among first-time examinees, the CE pass rate was 83.7% with any review course, 80.7% with no course, and 75.6% for the nonresponders, Dr. Malangoni said at the annual meeting of the Central Surgical Association.
Among those who had taken the CE before, pass rates were 77%, 69%, and 58%, respectively, with the intergroup difference statistically significant only for the nonresponders (P value = .01).
Despite the lack of benefit, however, most examinees (64%) believed that the review course improved their preparation for the CE, he said.
Those repeating the CE were significantly more likely than first-time examinees to take a review course (84.6% vs. 76.1%; P = .002).
Several candidates decided that multiple review courses might be better: 16% of the first-time examinees and 32% of the repeat examinees. Again, pass rates were not significantly different with multiple courses, Dr. Malangoni said.
The survey identified nine commercially available courses, but five were not analyzed because there were no enrollees or a low number (≤ 40) of enrollees. The remaining four courses were assigned a letter for anonymity. Enrollment in all courses ranged from 21 to 706 students.
In multivariate analysis, the only significant predictor for passing the initial CE was the qualifying examination scale score (Odds ratio, 1.09; P < .001). Course D trended toward a benefit, but the 99% confidence intervals overlapped and the P value did not meet the predetermined threshold of ≤ .01 (OR, 3.25; P = .02; 99% CI 0.86-12.22), he said.
For repeat examinees, no variables including the four review courses, gender, program size, or international medical graduation significantly predicted success on the CE exam.
“Given the time and effort, and expense, we feel that CE candidates should consider these results when assessing how best to prepare for this examination,” Dr. Malangoni concluded.
The study is not the first to question the benefit of review courses for already cash-strapped medical students and residents (N. Engl. J. Med. 2011:365:104-5), he noted.
Dr. Malangoni balked, however, at suggesting review courses may not be worth the investment for any candidate.
“Our results are applicable to a large group; however, it is not possible to determine when taking a review course would be beneficial for a specific candidate,” he said in an interview.
Dr. Malangoni reported having no financial disclosures.
On Twitter @pwendl
CHICAGO – A national survey of 1,246 residents found no evidence that taking a commercial board-review course provides any benefit in passing the American Board of Surgery certifying exam.
And none of the courses was significantly better than another, reported Dr. Mark Malangoni, an ACS Fellow and ABS associate executive director.
“Exam-review courses are now a multibillion-dollar industry … but there is little evidence to suggest they actually improve exam performance,” he said.
Dr. Malangoni and his ABS colleagues electronically surveyed 1,396 candidates who took the ABS certifying exam (CE) during the 2012-2013 academic year. Of the 1,246 who responded, 974 (78%) had taken a review course. Another 140 candidates declined to respond to the two-question survey, but their CE test results were available for comparison.
Among first-time examinees, the CE pass rate was 83.7% with any review course, 80.7% with no course, and 75.6% for the nonresponders, Dr. Malangoni said at the annual meeting of the Central Surgical Association.
Among those who had taken the CE before, pass rates were 77%, 69%, and 58%, respectively, with the intergroup difference statistically significant only for the nonresponders (P value = .01).
Despite the lack of benefit, however, most examinees (64%) believed that the review course improved their preparation for the CE, he said.
Those repeating the CE were significantly more likely than first-time examinees to take a review course (84.6% vs. 76.1%; P = .002).
Several candidates decided that multiple review courses might be better: 16% of the first-time examinees and 32% of the repeat examinees. Again, pass rates were not significantly different with multiple courses, Dr. Malangoni said.
The survey identified nine commercially available courses, but five were not analyzed because there were no enrollees or a low number (≤ 40) of enrollees. The remaining four courses were assigned a letter for anonymity. Enrollment in all courses ranged from 21 to 706 students.
In multivariate analysis, the only significant predictor for passing the initial CE was the qualifying examination scale score (Odds ratio, 1.09; P < .001). Course D trended toward a benefit, but the 99% confidence intervals overlapped and the P value did not meet the predetermined threshold of ≤ .01 (OR, 3.25; P = .02; 99% CI 0.86-12.22), he said.
For repeat examinees, no variables including the four review courses, gender, program size, or international medical graduation significantly predicted success on the CE exam.
“Given the time and effort, and expense, we feel that CE candidates should consider these results when assessing how best to prepare for this examination,” Dr. Malangoni concluded.
The study is not the first to question the benefit of review courses for already cash-strapped medical students and residents (N. Engl. J. Med. 2011:365:104-5), he noted.
Dr. Malangoni balked, however, at suggesting review courses may not be worth the investment for any candidate.
“Our results are applicable to a large group; however, it is not possible to determine when taking a review course would be beneficial for a specific candidate,” he said in an interview.
Dr. Malangoni reported having no financial disclosures.
On Twitter @pwendl
CHICAGO – A national survey of 1,246 residents found no evidence that taking a commercial board-review course provides any benefit in passing the American Board of Surgery certifying exam.
And none of the courses was significantly better than another, reported Dr. Mark Malangoni, an ACS Fellow and ABS associate executive director.
“Exam-review courses are now a multibillion-dollar industry … but there is little evidence to suggest they actually improve exam performance,” he said.
Dr. Malangoni and his ABS colleagues electronically surveyed 1,396 candidates who took the ABS certifying exam (CE) during the 2012-2013 academic year. Of the 1,246 who responded, 974 (78%) had taken a review course. Another 140 candidates declined to respond to the two-question survey, but their CE test results were available for comparison.
Among first-time examinees, the CE pass rate was 83.7% with any review course, 80.7% with no course, and 75.6% for the nonresponders, Dr. Malangoni said at the annual meeting of the Central Surgical Association.
Among those who had taken the CE before, pass rates were 77%, 69%, and 58%, respectively, with the intergroup difference statistically significant only for the nonresponders (P value = .01).
Despite the lack of benefit, however, most examinees (64%) believed that the review course improved their preparation for the CE, he said.
Those repeating the CE were significantly more likely than first-time examinees to take a review course (84.6% vs. 76.1%; P = .002).
Several candidates decided that multiple review courses might be better: 16% of the first-time examinees and 32% of the repeat examinees. Again, pass rates were not significantly different with multiple courses, Dr. Malangoni said.
The survey identified nine commercially available courses, but five were not analyzed because there were no enrollees or a low number (≤ 40) of enrollees. The remaining four courses were assigned a letter for anonymity. Enrollment in all courses ranged from 21 to 706 students.
In multivariate analysis, the only significant predictor for passing the initial CE was the qualifying examination scale score (Odds ratio, 1.09; P < .001). Course D trended toward a benefit, but the 99% confidence intervals overlapped and the P value did not meet the predetermined threshold of ≤ .01 (OR, 3.25; P = .02; 99% CI 0.86-12.22), he said.
For repeat examinees, no variables including the four review courses, gender, program size, or international medical graduation significantly predicted success on the CE exam.
“Given the time and effort, and expense, we feel that CE candidates should consider these results when assessing how best to prepare for this examination,” Dr. Malangoni concluded.
The study is not the first to question the benefit of review courses for already cash-strapped medical students and residents (N. Engl. J. Med. 2011:365:104-5), he noted.
Dr. Malangoni balked, however, at suggesting review courses may not be worth the investment for any candidate.
“Our results are applicable to a large group; however, it is not possible to determine when taking a review course would be beneficial for a specific candidate,” he said in an interview.
Dr. Malangoni reported having no financial disclosures.
On Twitter @pwendl
AT THE ANNUAL MEETING OF THE CENTRAL SURGICAL ASSOCIATION
Key clinical point: Commercial board-review courses do not improve the likelihood of passing the American Board of Surgery certifying exam.
Major finding: For first-time examinees, the pass rate was 83.7% with a review course, 80.7% with no course, and 75.6% for nonresponders.
Data source: Survey of 1,246 candidates taking the ABS certifying exam.
Disclosures: Dr. Malangoni reported having no financial disclosures.
Mobile health survey: Half of providers see patient benefit
CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.
The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.
Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.
The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.
About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.
Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.
Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”
Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.
“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.
Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.
When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.
For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.
“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.
The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.
On Twitter @legal_med
CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.
The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.
Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.
The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.
About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.
Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.
Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”
Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.
“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.
Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.
When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.
For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.
“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.
The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.
On Twitter @legal_med
CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.
The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.
Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.
The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.
About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.
Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.
Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”
Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.
“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.
Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.
When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.
For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.
“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.
The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.
On Twitter @legal_med
AT HIMSS15
ICD-10 update
When I last wrote about the International Classification of Diseases, 10th Revision (ICD-10) – last year, at about this time – the switchover was scheduled to take place on Oct. 1. Shortly thereafter, of course, Congress decided to delay the inevitable for 1 year. While the House Energy and Commerce Committee has hinted at the possibility of further postponements, we must all assume, until we hear otherwise, that the day of reckoning will arrive as scheduled. You will need to be ready if you expect to be paid come October.
Remember, on Sept. 30 you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.
First, decide which parts of your coding and billing systems – and EHR, if you have one – need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.
Coders and billers will need the most training on the new methodology, but physicians and other providers must also learn how the new codes are different from the old ones. In general, most differences are in specificity and level of documentation (left/right, acute/chronic, etc.), but there are new codes as well.
I suggest you start by identifying your most-used 20 or 30 diagnosis codes, and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this: Remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.
Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. That goes for you, too. This will not be a good time for you to be away, or for the office to run short-staffed.
Next, I suggest you contact all of your third-party payers, billing services, and clearinghouses. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.
Many payers and clearinghouses (including the Centers for Medicare & Medicaid Services) are staging test runs during which you can submit practice claims using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format; whether the code you used is appropriate; and whether the claim would have been accepted, rejected, or held pending additional information. You will need to do this for each payer, because each will have different coding policies. Many of those policies have not yet been released, and, in some cases, have not even been developed.
You can register for CMS testing sessions through your local Medicare Administrative Contractor (MAC) website. Use the sessions to test your internal system as well, to ensure that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers an assortment of training aids at its website, aad.org.
Even the best-laid plans can go awry, however, so it would be prudent to put aside a cash reserve or secure a line of credit to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments until early 2016.
You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels. I doubt it. In all probability, we will be using ICD-10 a lot longer than CMS originally planned. Besides, ICD-11 is essentially a refinement of ICD-10, not the significant departure that the 10th revision is over the 9th.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
When I last wrote about the International Classification of Diseases, 10th Revision (ICD-10) – last year, at about this time – the switchover was scheduled to take place on Oct. 1. Shortly thereafter, of course, Congress decided to delay the inevitable for 1 year. While the House Energy and Commerce Committee has hinted at the possibility of further postponements, we must all assume, until we hear otherwise, that the day of reckoning will arrive as scheduled. You will need to be ready if you expect to be paid come October.
Remember, on Sept. 30 you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.
First, decide which parts of your coding and billing systems – and EHR, if you have one – need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.
Coders and billers will need the most training on the new methodology, but physicians and other providers must also learn how the new codes are different from the old ones. In general, most differences are in specificity and level of documentation (left/right, acute/chronic, etc.), but there are new codes as well.
I suggest you start by identifying your most-used 20 or 30 diagnosis codes, and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this: Remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.
Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. That goes for you, too. This will not be a good time for you to be away, or for the office to run short-staffed.
Next, I suggest you contact all of your third-party payers, billing services, and clearinghouses. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.
Many payers and clearinghouses (including the Centers for Medicare & Medicaid Services) are staging test runs during which you can submit practice claims using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format; whether the code you used is appropriate; and whether the claim would have been accepted, rejected, or held pending additional information. You will need to do this for each payer, because each will have different coding policies. Many of those policies have not yet been released, and, in some cases, have not even been developed.
You can register for CMS testing sessions through your local Medicare Administrative Contractor (MAC) website. Use the sessions to test your internal system as well, to ensure that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers an assortment of training aids at its website, aad.org.
Even the best-laid plans can go awry, however, so it would be prudent to put aside a cash reserve or secure a line of credit to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments until early 2016.
You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels. I doubt it. In all probability, we will be using ICD-10 a lot longer than CMS originally planned. Besides, ICD-11 is essentially a refinement of ICD-10, not the significant departure that the 10th revision is over the 9th.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
When I last wrote about the International Classification of Diseases, 10th Revision (ICD-10) – last year, at about this time – the switchover was scheduled to take place on Oct. 1. Shortly thereafter, of course, Congress decided to delay the inevitable for 1 year. While the House Energy and Commerce Committee has hinted at the possibility of further postponements, we must all assume, until we hear otherwise, that the day of reckoning will arrive as scheduled. You will need to be ready if you expect to be paid come October.
Remember, on Sept. 30 you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.
First, decide which parts of your coding and billing systems – and EHR, if you have one – need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.
Coders and billers will need the most training on the new methodology, but physicians and other providers must also learn how the new codes are different from the old ones. In general, most differences are in specificity and level of documentation (left/right, acute/chronic, etc.), but there are new codes as well.
I suggest you start by identifying your most-used 20 or 30 diagnosis codes, and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this: Remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.
Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. That goes for you, too. This will not be a good time for you to be away, or for the office to run short-staffed.
Next, I suggest you contact all of your third-party payers, billing services, and clearinghouses. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.
Many payers and clearinghouses (including the Centers for Medicare & Medicaid Services) are staging test runs during which you can submit practice claims using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format; whether the code you used is appropriate; and whether the claim would have been accepted, rejected, or held pending additional information. You will need to do this for each payer, because each will have different coding policies. Many of those policies have not yet been released, and, in some cases, have not even been developed.
You can register for CMS testing sessions through your local Medicare Administrative Contractor (MAC) website. Use the sessions to test your internal system as well, to ensure that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers an assortment of training aids at its website, aad.org.
Even the best-laid plans can go awry, however, so it would be prudent to put aside a cash reserve or secure a line of credit to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments until early 2016.
You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels. I doubt it. In all probability, we will be using ICD-10 a lot longer than CMS originally planned. Besides, ICD-11 is essentially a refinement of ICD-10, not the significant departure that the 10th revision is over the 9th.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
Senate passes SGR repeal
The Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act, April 14 by a vote of 92-8.
The bill matches the language that the House passed by an overwhelming majority on March 26 and clears the way for the White House to permanently end the practice of temporary “doc fix” patches necessitated by the Medicare Sustainable Growth Rate formula.
President Obama signed the bill into law April 16.
The bill also extends funding for the Children’s Health Insurance Program for 2 years.
A number of amendments, including attempts to reauthorize CHIP for 4 years and to enforce pay-as-you-go rules that require the bill be fully offset, did not gain the necessary 60 votes for adoption.
The latest cut, a 21% reduction to Medicare physician payments went into effect on April 1, but the Centers for Medicare & Medicaid Services has been holding off on paying claims in anticipation of the bill’s passage. The agency had planned to pay the difference of the claims retroactively if there was a further delay in the passage.
*This article was updated April 17, 2015.
The Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act, April 14 by a vote of 92-8.
The bill matches the language that the House passed by an overwhelming majority on March 26 and clears the way for the White House to permanently end the practice of temporary “doc fix” patches necessitated by the Medicare Sustainable Growth Rate formula.
President Obama signed the bill into law April 16.
The bill also extends funding for the Children’s Health Insurance Program for 2 years.
A number of amendments, including attempts to reauthorize CHIP for 4 years and to enforce pay-as-you-go rules that require the bill be fully offset, did not gain the necessary 60 votes for adoption.
The latest cut, a 21% reduction to Medicare physician payments went into effect on April 1, but the Centers for Medicare & Medicaid Services has been holding off on paying claims in anticipation of the bill’s passage. The agency had planned to pay the difference of the claims retroactively if there was a further delay in the passage.
*This article was updated April 17, 2015.
The Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act, April 14 by a vote of 92-8.
The bill matches the language that the House passed by an overwhelming majority on March 26 and clears the way for the White House to permanently end the practice of temporary “doc fix” patches necessitated by the Medicare Sustainable Growth Rate formula.
President Obama signed the bill into law April 16.
The bill also extends funding for the Children’s Health Insurance Program for 2 years.
A number of amendments, including attempts to reauthorize CHIP for 4 years and to enforce pay-as-you-go rules that require the bill be fully offset, did not gain the necessary 60 votes for adoption.
The latest cut, a 21% reduction to Medicare physician payments went into effect on April 1, but the Centers for Medicare & Medicaid Services has been holding off on paying claims in anticipation of the bill’s passage. The agency had planned to pay the difference of the claims retroactively if there was a further delay in the passage.
*This article was updated April 17, 2015.
Health data breaches compromised 29 million patient records in 2010-2013
Some 29 million private patient health records were compromised between 2010 and the end of 2013 – mostly as a result of criminal activity, say researchers, who described their findings as a likely underestimate of the magnitude of the problem.
In a research letter published April 14 in JAMA (doi:10.1001/jama.2015.2252), Dr. Vincent Liu of Kaiser Permanente in Oakland, Calif., and his colleagues at Stanford (Calif.) University, evaluated U.S. Department of Health & Human Services reports of data breaches involving 500 or more patient records covered under the Health Insurance Portability and Accountability Act (HIPAA). Of the 949 reported breach events during the 4-year study period, 67% involved electronic media while about 20% were attributed to paper records. Laptop or portable device theft accounted for 33% of all breaches reported.
Importantly, the frequency of breaches from hacking and unauthorized access increased significantly during the study period (from 12% in 2010 to 27% in 2013), and breaches involving external vendors represented 29% of all incidents.
“Given the rapid expansion in electronic health record deployment since 2012, as well as the expected increase in cloud-based services provided by vendors supporting predictive analytics, personal health records, health-related sensors, and gene-sequencing technology, the frequency and scope of electronic health care data breaches are likely to increase,” Dr. Liu and colleagues wrote.
“Our study was limited to breaches that were already recognized, reported, and affecting at least 500 individuals [as required by the HITECH Act of 2009],” Dr. Liu and colleagues wrote. “Therefore, our study likely underestimated the true number of health care data breaches occurring each year.” The study was funded by Permanente Medical Group and the National Institutes of Health. None of its authors reported any relevant conflicts of interest.
Dr. Liu and his colleagues’ research makes clear that the personal health information of patients in the United States is not safe, and it needs to be. Loss of trust in an electronic health information system could seriously undermine efforts to improve health and health care in the United States. The question is what to do.
Part of the responsibility lies with the private custodians of health data, mostly clinicians, health care organizations, and insurers. Although malicious hacking gets the most media attention, the majority of data breaches result from a much more mundane and correctable problem: the failure of covered entities to observe what might be called good data hygiene.
But part of the responsibility also lies with policy makers. Health care organizations and practitioners bemoan HIPAA’s requirements, but in fact the law is antiquated and inadequate to protect patients’ health care privacy and security. The fact that HIPAA regulates only certain entities that hold health data, rather than regulating health data wherever those data reside, seems illogical in today’s digital world.
Dr. David Blumenthal is president of the Commonwealth Fund in New York; Deven McGraw is a health care attorney in Washington. Their comments were made in an editorial accompanying the study (JAMA 2015 [doi:10.1001/jama.2015.2746]). They reported no conflicts of interest related to their comments.
Dr. Liu and his colleagues’ research makes clear that the personal health information of patients in the United States is not safe, and it needs to be. Loss of trust in an electronic health information system could seriously undermine efforts to improve health and health care in the United States. The question is what to do.
Part of the responsibility lies with the private custodians of health data, mostly clinicians, health care organizations, and insurers. Although malicious hacking gets the most media attention, the majority of data breaches result from a much more mundane and correctable problem: the failure of covered entities to observe what might be called good data hygiene.
But part of the responsibility also lies with policy makers. Health care organizations and practitioners bemoan HIPAA’s requirements, but in fact the law is antiquated and inadequate to protect patients’ health care privacy and security. The fact that HIPAA regulates only certain entities that hold health data, rather than regulating health data wherever those data reside, seems illogical in today’s digital world.
Dr. David Blumenthal is president of the Commonwealth Fund in New York; Deven McGraw is a health care attorney in Washington. Their comments were made in an editorial accompanying the study (JAMA 2015 [doi:10.1001/jama.2015.2746]). They reported no conflicts of interest related to their comments.
Dr. Liu and his colleagues’ research makes clear that the personal health information of patients in the United States is not safe, and it needs to be. Loss of trust in an electronic health information system could seriously undermine efforts to improve health and health care in the United States. The question is what to do.
Part of the responsibility lies with the private custodians of health data, mostly clinicians, health care organizations, and insurers. Although malicious hacking gets the most media attention, the majority of data breaches result from a much more mundane and correctable problem: the failure of covered entities to observe what might be called good data hygiene.
But part of the responsibility also lies with policy makers. Health care organizations and practitioners bemoan HIPAA’s requirements, but in fact the law is antiquated and inadequate to protect patients’ health care privacy and security. The fact that HIPAA regulates only certain entities that hold health data, rather than regulating health data wherever those data reside, seems illogical in today’s digital world.
Dr. David Blumenthal is president of the Commonwealth Fund in New York; Deven McGraw is a health care attorney in Washington. Their comments were made in an editorial accompanying the study (JAMA 2015 [doi:10.1001/jama.2015.2746]). They reported no conflicts of interest related to their comments.
Some 29 million private patient health records were compromised between 2010 and the end of 2013 – mostly as a result of criminal activity, say researchers, who described their findings as a likely underestimate of the magnitude of the problem.
In a research letter published April 14 in JAMA (doi:10.1001/jama.2015.2252), Dr. Vincent Liu of Kaiser Permanente in Oakland, Calif., and his colleagues at Stanford (Calif.) University, evaluated U.S. Department of Health & Human Services reports of data breaches involving 500 or more patient records covered under the Health Insurance Portability and Accountability Act (HIPAA). Of the 949 reported breach events during the 4-year study period, 67% involved electronic media while about 20% were attributed to paper records. Laptop or portable device theft accounted for 33% of all breaches reported.
Importantly, the frequency of breaches from hacking and unauthorized access increased significantly during the study period (from 12% in 2010 to 27% in 2013), and breaches involving external vendors represented 29% of all incidents.
“Given the rapid expansion in electronic health record deployment since 2012, as well as the expected increase in cloud-based services provided by vendors supporting predictive analytics, personal health records, health-related sensors, and gene-sequencing technology, the frequency and scope of electronic health care data breaches are likely to increase,” Dr. Liu and colleagues wrote.
“Our study was limited to breaches that were already recognized, reported, and affecting at least 500 individuals [as required by the HITECH Act of 2009],” Dr. Liu and colleagues wrote. “Therefore, our study likely underestimated the true number of health care data breaches occurring each year.” The study was funded by Permanente Medical Group and the National Institutes of Health. None of its authors reported any relevant conflicts of interest.
Some 29 million private patient health records were compromised between 2010 and the end of 2013 – mostly as a result of criminal activity, say researchers, who described their findings as a likely underestimate of the magnitude of the problem.
In a research letter published April 14 in JAMA (doi:10.1001/jama.2015.2252), Dr. Vincent Liu of Kaiser Permanente in Oakland, Calif., and his colleagues at Stanford (Calif.) University, evaluated U.S. Department of Health & Human Services reports of data breaches involving 500 or more patient records covered under the Health Insurance Portability and Accountability Act (HIPAA). Of the 949 reported breach events during the 4-year study period, 67% involved electronic media while about 20% were attributed to paper records. Laptop or portable device theft accounted for 33% of all breaches reported.
Importantly, the frequency of breaches from hacking and unauthorized access increased significantly during the study period (from 12% in 2010 to 27% in 2013), and breaches involving external vendors represented 29% of all incidents.
“Given the rapid expansion in electronic health record deployment since 2012, as well as the expected increase in cloud-based services provided by vendors supporting predictive analytics, personal health records, health-related sensors, and gene-sequencing technology, the frequency and scope of electronic health care data breaches are likely to increase,” Dr. Liu and colleagues wrote.
“Our study was limited to breaches that were already recognized, reported, and affecting at least 500 individuals [as required by the HITECH Act of 2009],” Dr. Liu and colleagues wrote. “Therefore, our study likely underestimated the true number of health care data breaches occurring each year.” The study was funded by Permanente Medical Group and the National Institutes of Health. None of its authors reported any relevant conflicts of interest.
FROM JAMA
Key clinical point: Breaches of electronic patient data are becoming more frequent.
Major finding: Data from 29.1 million HIPAA-protected patient health records were compromised by computer theft, hacking, inappropriate electronic dissemination, and other causes over a 4-year period.
Data source: A review of HHS records on health data breaches involving 500 or more individuals occurring from 2010 through the end of 2013.
Disclosures: None.
Health IT Roadmap draws comments
CHICAGO – The federal government’s Shared Nationwide Interoperability Roadmap lays out a grand vision for a single health IT ecosystem, but will it be able to enforce its own standards or be able to meaningfully incorporate the flood of patient-provided data in an era of Fitbits and Apple watches?
Those were just a few of the concerns heard by the officials from the Office of the National Coordinator for Health Information Technology (ONC) at the annual meeting of the Healthcare Information and Management Systems Society.
During a listening session on the Roadmap, one attendee called for oversight and a transparent process to handle complaints much like the airline industry has for lost luggage, observing that providers already have a hard time getting industry to recognize and “play ball” with each other.
Rules of engagement and governance are one of the core building blocks of the Roadmap, with the ONC establishing a governance framework with rules of the road and identifying a mechanism to recognize organizations that comply with that framework. That could be thought of as a mechanism for advancing some accountability, but it’s important to remember that participation in that process will be voluntary, according to Erica Galvez, interoperability portfolio manager at ONC.
“So unless that’s tied to other policy levers ... or other enforcement authorities, ONC, given its current authority, has quite a few limitations on its ability to actually affect the type of enforcement you’re alluding to,” she added.
The ONC does have proposals for in-field surveillance of products and additional transparency requirements associated with products, said Steven Posnack, director of the ONC Office of Standards and Technology. Still, the ONC doesn’t necessarily have all the “arrows and quivers” needed to affect the enforcement and accountability some would like, he acknowledged.
Core technical standards and functions designed to help achieve the Roadmap’s 3-, 6-, and 10-year milestones include consistent data formats and semantics; consistent, secure transport techniques; standard, secure services; accurate patient identity matching; and reliable resource location.
One physician attendee called for standardizing the standards themselves, noting that there are more than 150 terminologies in use, each with its own idiosyncrasies. One approach may be to follow the example set by global IT organizations like Facebook, LinkedIn, and Yahoo, which converged on using the Web standards as a means to have persistent, authoritative URIs (uniform resource identifiers) that can be shared globally, he suggested to a round of applause.
Another attendee called for future drafts of the Roadmap to address an increasing trend among biopharmaceutical companies to create their own portals or mobile apps for a specific therapy, which requires providers to download multiple infrastructures to support various therapies.
Still another attendee artfully asked that Departments of Defense and Veterans Affairs medical records be incorporated into the proposed nationwide IT system to ensure meaningful longitudinal care for veterans.
There was little audience discussion about the Roadmap’s other core building blocks of a common clinical data set or privacy and security. Concerns about medical device interoperability, however, were raised from the floor and have been echoed in the public comments received by the ONC, Ms. Galvez said.
She stressed that the Roadmap is a shared plan that attempts to capture both public and private sector activities.
“We’re not going to achieve interoperability at the scale we are attempting with government action alone,” Ms. Galvez said. “In looking at some of the early public comments, I will say I have not seen as many commitments from folks as I would really like to see. I’d really like to see organizations coming forward and saying ‘There’s a call to action in this space, we think there’s something we can do about that, and here’s what we’re willing to do.’ ”
The public comment period on the Roadmap officially closed April 3, but comments on the ONC’s 2015 Interoperability Standards Advisory will be accepted through May 1.
CHICAGO – The federal government’s Shared Nationwide Interoperability Roadmap lays out a grand vision for a single health IT ecosystem, but will it be able to enforce its own standards or be able to meaningfully incorporate the flood of patient-provided data in an era of Fitbits and Apple watches?
Those were just a few of the concerns heard by the officials from the Office of the National Coordinator for Health Information Technology (ONC) at the annual meeting of the Healthcare Information and Management Systems Society.
During a listening session on the Roadmap, one attendee called for oversight and a transparent process to handle complaints much like the airline industry has for lost luggage, observing that providers already have a hard time getting industry to recognize and “play ball” with each other.
Rules of engagement and governance are one of the core building blocks of the Roadmap, with the ONC establishing a governance framework with rules of the road and identifying a mechanism to recognize organizations that comply with that framework. That could be thought of as a mechanism for advancing some accountability, but it’s important to remember that participation in that process will be voluntary, according to Erica Galvez, interoperability portfolio manager at ONC.
“So unless that’s tied to other policy levers ... or other enforcement authorities, ONC, given its current authority, has quite a few limitations on its ability to actually affect the type of enforcement you’re alluding to,” she added.
The ONC does have proposals for in-field surveillance of products and additional transparency requirements associated with products, said Steven Posnack, director of the ONC Office of Standards and Technology. Still, the ONC doesn’t necessarily have all the “arrows and quivers” needed to affect the enforcement and accountability some would like, he acknowledged.
Core technical standards and functions designed to help achieve the Roadmap’s 3-, 6-, and 10-year milestones include consistent data formats and semantics; consistent, secure transport techniques; standard, secure services; accurate patient identity matching; and reliable resource location.
One physician attendee called for standardizing the standards themselves, noting that there are more than 150 terminologies in use, each with its own idiosyncrasies. One approach may be to follow the example set by global IT organizations like Facebook, LinkedIn, and Yahoo, which converged on using the Web standards as a means to have persistent, authoritative URIs (uniform resource identifiers) that can be shared globally, he suggested to a round of applause.
Another attendee called for future drafts of the Roadmap to address an increasing trend among biopharmaceutical companies to create their own portals or mobile apps for a specific therapy, which requires providers to download multiple infrastructures to support various therapies.
Still another attendee artfully asked that Departments of Defense and Veterans Affairs medical records be incorporated into the proposed nationwide IT system to ensure meaningful longitudinal care for veterans.
There was little audience discussion about the Roadmap’s other core building blocks of a common clinical data set or privacy and security. Concerns about medical device interoperability, however, were raised from the floor and have been echoed in the public comments received by the ONC, Ms. Galvez said.
She stressed that the Roadmap is a shared plan that attempts to capture both public and private sector activities.
“We’re not going to achieve interoperability at the scale we are attempting with government action alone,” Ms. Galvez said. “In looking at some of the early public comments, I will say I have not seen as many commitments from folks as I would really like to see. I’d really like to see organizations coming forward and saying ‘There’s a call to action in this space, we think there’s something we can do about that, and here’s what we’re willing to do.’ ”
The public comment period on the Roadmap officially closed April 3, but comments on the ONC’s 2015 Interoperability Standards Advisory will be accepted through May 1.
CHICAGO – The federal government’s Shared Nationwide Interoperability Roadmap lays out a grand vision for a single health IT ecosystem, but will it be able to enforce its own standards or be able to meaningfully incorporate the flood of patient-provided data in an era of Fitbits and Apple watches?
Those were just a few of the concerns heard by the officials from the Office of the National Coordinator for Health Information Technology (ONC) at the annual meeting of the Healthcare Information and Management Systems Society.
During a listening session on the Roadmap, one attendee called for oversight and a transparent process to handle complaints much like the airline industry has for lost luggage, observing that providers already have a hard time getting industry to recognize and “play ball” with each other.
Rules of engagement and governance are one of the core building blocks of the Roadmap, with the ONC establishing a governance framework with rules of the road and identifying a mechanism to recognize organizations that comply with that framework. That could be thought of as a mechanism for advancing some accountability, but it’s important to remember that participation in that process will be voluntary, according to Erica Galvez, interoperability portfolio manager at ONC.
“So unless that’s tied to other policy levers ... or other enforcement authorities, ONC, given its current authority, has quite a few limitations on its ability to actually affect the type of enforcement you’re alluding to,” she added.
The ONC does have proposals for in-field surveillance of products and additional transparency requirements associated with products, said Steven Posnack, director of the ONC Office of Standards and Technology. Still, the ONC doesn’t necessarily have all the “arrows and quivers” needed to affect the enforcement and accountability some would like, he acknowledged.
Core technical standards and functions designed to help achieve the Roadmap’s 3-, 6-, and 10-year milestones include consistent data formats and semantics; consistent, secure transport techniques; standard, secure services; accurate patient identity matching; and reliable resource location.
One physician attendee called for standardizing the standards themselves, noting that there are more than 150 terminologies in use, each with its own idiosyncrasies. One approach may be to follow the example set by global IT organizations like Facebook, LinkedIn, and Yahoo, which converged on using the Web standards as a means to have persistent, authoritative URIs (uniform resource identifiers) that can be shared globally, he suggested to a round of applause.
Another attendee called for future drafts of the Roadmap to address an increasing trend among biopharmaceutical companies to create their own portals or mobile apps for a specific therapy, which requires providers to download multiple infrastructures to support various therapies.
Still another attendee artfully asked that Departments of Defense and Veterans Affairs medical records be incorporated into the proposed nationwide IT system to ensure meaningful longitudinal care for veterans.
There was little audience discussion about the Roadmap’s other core building blocks of a common clinical data set or privacy and security. Concerns about medical device interoperability, however, were raised from the floor and have been echoed in the public comments received by the ONC, Ms. Galvez said.
She stressed that the Roadmap is a shared plan that attempts to capture both public and private sector activities.
“We’re not going to achieve interoperability at the scale we are attempting with government action alone,” Ms. Galvez said. “In looking at some of the early public comments, I will say I have not seen as many commitments from folks as I would really like to see. I’d really like to see organizations coming forward and saying ‘There’s a call to action in this space, we think there’s something we can do about that, and here’s what we’re willing to do.’ ”
The public comment period on the Roadmap officially closed April 3, but comments on the ONC’s 2015 Interoperability Standards Advisory will be accepted through May 1.
AT HIMSS15
