Feature Articles

VA Tackles Medical Device Vulnerabilities and Cyberthreats

VA recently signed partnerships with Massachusetts General Hospital and Shepherd University. This collaboration's research will address cybersecurity and compatibility measures needed in devices used for VA patient care. It will also refine existing and emerging cybersecurity standards and practices for network connectable medical devices, medical data systems and other related technology. Beyond VA, the agreements could have a broad impact in standardizing cybersecurity and safety requirements within the larger public health sector. VA is contributing to industry-wide awareness of both medical device vulnerabilities and threats, while applying further tests of the Underwriters Laboratories criteria and other emerging standards.

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Mortal Coils: Why We Must Stop Tolerating Failing Health Tech

Today, data are scattered across thousands of database tables within any single electronic medical record (EMR) system, but also across dozens of other systems that hold pharmacy data, imaging data, insurance data, laboratory data, etc. Pretty much none of it is available on demand in any given clinical setting. The inevitable result of this disconnected galaxy of data "black holes" is mistakes, or if not outright mistakes, well-intentioned missteps based on lack of background data within the acute-care setting.

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CMS Promoting Interoperability in 2021: All good things must come to an end?

We have spent years involved with the management of the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Incentive Programs which were created by the HITECH Act (2009). These programs were recently renamed Promoting Interoperability (PI) programs. In a nutshell, these programs were tied to the Medicare and Medicaid insurance programs and provided financial incentives over a number of years to ambulatory providers and hospitals to adopt and use EHRs. Vendors submitted their technology products for testing and certification that they performed specific functions and could exchange data using specified message formats...But the provisions of the HITECH Act are due to expire on September 30, 2021 (see CMS timeline). These are the programs affected...

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How The VA and UL Created an Orchestrated Approach to Healthcare Cybersecurity Assurance

In today's high-risk Internet of Medical Things (IoMT) and cyber-warfare environment, one tool or individual line of cybersecurity solutions would likely not be able to satisfy the requirements for security and safety put forth by an HDO; hence, the aggregation of solutions branded as MedFusion was derived. The VA UL CRADA discovered that healthcare is strengthened in terms of security and safety of connectable medical devices through in-depth cybersecurity defense...Learning from the VA and UL cybersecurity research results, with respect to product-level management of vulnerabilities and threats to medical devices and their associated software algorithms, we can impact the quality of adoption of electronic health records and other data collection systems connected to the IoMT and consumers...

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What Are We Prepared to Do in the United States to Save Primary Care?

I propose two significant changes to help make primary care relevant in the 21st century...I wrote a longer piece on [Virtual Care] earlier in the year. In short, it's a disgrace that we've put so many hurdles on telemedicine, and that it continues to be so underused. It is widely available in health plans, but rarely practiced by physicians nor by patients. Instead, we still mostly go to our doctors offices, to ERs, or perhaps now to drugstores.A televisit should be the first course of action for non-emergencies. We must remove regulatory and reimbursement barriers, and incent patients to take advantage of the speed and convenience of the option. Moreover, as AI options for diagnoses and advice quickly become more viable, we can use them to triage our needs, help assure continuity with physicians, and eventually reduce the need to talk to a human...

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The Current State of Blockchain and Where it's Going

In an earlier post, Blockchain evolution: A quick guide and why open source is at the heart of it, I discussed the first generations of blockchains: the public Bitcoin and cryptocurrency blockchains, followed by the Ethereum blockchain capable of executing programs ("smart contracts"), leading to permissioned versions of code-executing blockchains (e.g., Hyperledger Fabric, Quorum). Let's step back into the blockchain jungle and take a look at the current state of the ecosystem and the projects trying to solve some of the limitations of blockchain technology: speed and throughput, cross-blockchain information and value exchange, governance, and identity and account management.

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Let's Place Some Big Bets - Reinventing Medical Care

When we think about market research and Big Data, think about Henry Ford's (possibly apocryphal) quote: Most of our healthcare innovations and reforms take the existing healthcare system as a given and try to build upon it in some way. They add more on-ramps to the healthcare superhighway, widen its lanes, try to smooth the pavements, maybe even automate our driving on it. But sometimes we need to tear the highway down. Here, in brief, are some big bets I'd like to see someone take on...

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New Report: Top Challenges Facing HHS Includes Harnessing Data

In November 2019 the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a new report, Top Management and Performance Challenges Facing HHS. Divided into six major sections, this report reviews the OIG's observations with respect to financial integrity of HHS programs, value and quality, protecting the health and safety of beneficiaries as well as the public at large, harnessing data to achieve these goals, and working across government. The fifth challenge, "Harnessing Data To Improve Health and Well-Being of Individuals," is particularly foundational. Read More »

Towards a New EHR Metaphor - Or, How to Fix Unusable EHRs

News flash: docs hate Excel! In a recent study, which included researchers from Yale, the Mayo Clinic, Stanford, and the AMA, physicians rated it only at 57% on a usability rating, far below Google search (93%), Amazon (82%), or even Word (76%). But, of course, Excel wasn't their real problem; the study was aimed at electronic health records (EHRs), which physicians rated even lower: 45%, which the study authors graded an "F." If we want EHRs get better, though, we may need to start with a new metaphor for them.Lead author Edward Melnick, MD, explained the usability issue: "A Google search is easy. There's not a lot of learning or memorization; it's not very error-prone. Excel, on the other hand, is a super-powerful platform, but you really have to study how to use it. EHRs mimic that."

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What Western States Can Learn From Native American Wildfire Management Strategies

News media coverage of wildfires commonly frames them as "natural disasters" - dangerous elements of the natural world over which humans have little control. The language of climate change, fear of fire and the sense that it has become inevitable can be overwhelming, leaving people with the view that little can be done to manage these events. But in fact, people aren't helpless. While fires can be dangerous, they are inevitable and necessary in many ecosystems, and humans have long adapted to them. Across North America, indigenous peoples have actively managed forest ecosystems through the use of fire. Euro-American settlers were struck by the rich biodiversity of California's forests, woodlands and prairies, but they didn't understand that indigenous people's use of fire was responsible for them.

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Instead of Medicare for All, How about VA for All?

I wonder -- why would people be calling for a new system that would still have thousands of private hospitals/facilities and millions of healthcare professionals, practicing FFS medicine using countless systems and data structures? In short, why aren't people calling for VA for All? Like Medicare, the VA -- more especially, its healthcare component, the Veterans Health Administration -- is charged with providing healthcare to a designed population, in this case, veterans. Unlike Medicare, though, it does so as an integrated health system (by far the largest in the U.S.), with 170 VA Medical Centers, over a thousand outpatient facilities, and somewhere over 100,000 physicians...it offers some of the finest care in the world. It offers a range of services that Medicare can only dream of, and it does so at, it is believed, lower costs than private coverage or even Medicare. Plus, it also was an innovator in electronic health records and is today in telehealth. What's not to like?

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Getting Started With Pimcore: An Open Source Alternative For Product Information Management

Product information management (PIM) software enables sellers to consolidate product data into a centralized repository that acts as a single source of truth, minimizing errors and redundancies in product data. This, in turn, makes it easier to share high-quality, clear, and accurate product information across customer touchpoints, paving the way for rich, consistent, readily accessible content that's optimized for all the channels customers use, including websites, social platforms, marketplaces, apps, IoT devices, conversational interfaces, and even print catalogs and physical stores...For years, there have been proprietary products that address some of these needs, like Salsify for data management, Adobe Experience Manager, and SAP Commerce Cloud for experience management, but now there's an open source alternative called Pimcore. Read More »

Transforming Health Care Through A 360-Degree View Of Data

How medical care can be substantially improved through a full spectrum view of all factors that affect health was the topic of Payam Etminani's presentation at the 2019 IDGA Veterans Benefits Conference in Washington D.C. Etminani, the CEO of Bitscopic, argued that the ability to view all health data including social, environmental and genomic information in addition to the traditional clinical measures (vital signs, blood work, history of illness etc), would lead to significant improvement in care. Etminani described how recent advances in Big Data and Artificial Intelligence (AI) make combining and using these large and widely varied sets of information possible. Read More »

The Community-Led Renaissance of Open Source

In a revival and expansion of the principles that drove the first generation of community-led open source commercial players, creators are now coming together in a new form of collaboration. Rather than withholding software under a different license, they're partnering with each other to provide the same kinds of professional assurances that companies such as Red Hat discovered were necessary back in the day, but for the thousands of discrete components that make up the modern development platform. Today's generation of entrepreneurial open source creators is leaving behind the scarcity mindset that bore open core and its brethren. Instead, they're advancing an optimistic, additive, and still practical model that adds missing commercial value on top of raw open source.

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ONC Patient Matching Project Moving Forward...Slowly

Last week, the Office of the National Coordinator for Health Information Technology (ONC) released the final report from its Patient Matching, Aggregation, and Linking (PMAL) Project, as well as an additional report describing a pilot project to test the Patient Demographic Data Quality Framework (PDDQ) to Support Patient Matching that was released several years ago. Funded from June 2015 through September 2018 by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) through the Patient-Centered Outcomes Research (PCOR) Trust Fund, PMAL was one of the activities I described in an earlier post. The Final Report reviews the four challenged of patient matching and linking that the PMAL project attempted to address...

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