Saturday, July 4, 2015


European health information technology development parallels the United States of America. 

This post encompasses advances in Europe.

The Proceedings included 1039 individual papers presented during the conference.

Complete Content from Proceedings

Subject index: 1041
Author index:  1051

excerpted from the Proceedings of the MIE 2015, published by IOS Press.

DIGITAL HEALTHCARE EMPOWERING EUROPEANS is an exhaustive and encyclopedic recording of the proceedings of MIE 2015 .  It is a comprehensive collection of academic papers from a wide range of institutions by known authorities in the area of health information technology and it's impact on the citizens of Europe.

This post should serve as a starting point to explore the book, available via an open source publisher
for a global audience via the internet. DIGITAL HEALTHCARE EMPOWERING EUROPEANS  is protected by a creative commons license, and subject to the regulations thereof.

This volume contains the proceedings of the MIE2015 conference, “Digital healthcare empowering Europeans”, highlighting the impact that digitisation has on all citizens, medical staff, patients and their carers. Over decades digitisation of healthcare has become almost ubiquitous, spreading from healthcare organisations into the homes and personal appliances of practically every citizen.

Similarly, biomedical and health informatics has spread from dedicated manufacturers to the largest information technology companies. MIE2015, the 26th Medical Informatics in Europe Conference, has been jointly organised by the European Federation for Medical Informatics (EFMI) and the Spanish Society of Health Informatics (SEIS), organisations which were both established in 1976. MIE2015 takes place in the splendid city of Madrid, Spain, from May 27th to 29th, 2015. EFMI is a federation of national medical informatics associations from 30 European countries, and its purpose is to develop and disseminate knowledge and expertise in the field of biomedical and health informatics.

Besides the national associations, the working groups, which include experts in specialist fields ranging from electronic patient records, medical imaging, and evaluation to nursing and rehabilitation, are the main channel through which new knowledge and ideas are developed and disseminated. “Digital healthcare empowering Europeans”, the theme of MIE2015, is addressing a range of important aspects, relating to opportunities for or impact of new approaches and IT tools in day-to-day life affecting the citizens. The conference theme aligns with collective efforts of multiple parties: patients, care providers, system developers, researchers, and ultimately the entire population of Europe to join in to enjoy benefits that digitisation of health information offers. Digitisation enables involvement of people in management of their own health and empowers people to be in more control of all aspects of their health and for the care they require. The conference provokes discussions of inherent challenges to design and adequately deploy ICT tools, to assess health IT interventions, train users, and exploit available information and knowledge to scrutinise visions for continuous and ubiquitous availability and interoperability in health care.

MIE2015 brings together participants that share their latest achievements in biomedical and health informatics, including the role of the user in digital healthcare, where interdisciplinary collaboration may achieve care, and treatment processes supporting quality of life for citizens, healthcare providers, and the society. Contributions address methodologies and applications, success stories and lessons learned as well as an outlook on on-going projects and directions for the future.

The scope of the book is truly impressive. Here are some of the topics:

Incidence Rate of Canonical vs. Derived Medical Terminology in Natural Language
Observing Health Professionals’ Workflow Patterns for Diabetes Care – First Steps Towards an Ontology for EHR Services
Health Consumer-Oriented Information Retrieval
Reuse of EHRs to Support Clinical Research in a Hospital of Reference

Implementability of Stroke Guidelines: A Pragmatic Comparison Between US and European Recommendations Using eGLIA
Clinical Data Warehousing for Evidence Based Decision Making
Approach to Extract Billing Data from Medical Documentation in Russia – Lessons Learned
Integrated Wireless Sensor Network for Monitoring Pregnant Women
Nurses’ Expectations and Perceptions of a Redesigned Electronic Health Record

Supporting in- and off-Hospital Patient Management Using a Web-Based Integrated Software Platform
Internet-Based Remote Consultations – General Practitioner Experience and Attitudes in Norway and Germany
A WSN Healthcare Monitoring System for Elderly People in Geriatric Facilities
Internet of Things for an Age-Friendly Healthcare
A Big Data-Driven Model for the Optimization of Healthcare Processes

Ethical, Legal and Social Issues Related to the Health Data-Warehouses: Re-Using Health Data in the Research and Public Health Research
Mobile Health Apps in Sweden: What Do Physicians Recommend?
The Impact of eHealth and mHealth on Doctor Behavior and Patient Involvement: An Israeli and Portuguese Comparative Approach
A Cloud Based Real-Time Collaborative Platform for eHealth

In addition to the formal papers there were over 100 posters at the meeting

Friday, July 3, 2015

Ingestible Sensor technology--Wearable, on the Inside

First Medical Device Cleared by FDA With Adherence Claim

Patient ingests medication by mouth

Wireless Receiver Applied to arm or abdomen, transmits signal to Smart Device
or other monitor

Micro-chip embedded in Pill
Proteus Digital Health, Inc. today announced that the FDA has expanded the Indications for Use statement for the latest generation of its Ingestible Sensor technology, enabling the device to be used as an aid in the measurement of medication adherence. To the Company’s knowledge, this is the only device with an FDA-sanctioned claim for measuring medication adherence.
“We are delighted that our collaborative work with the FDA continues to enable positive progress”
An estimated 50% of us do not take our medicines as prescribed, potentially limiting the therapeutic effectiveness of our medicine and resulting in $100-300 billion in avoidable healthcare costs in the US alone due to unnecessary escalation of treatment.1 There have been many efforts to address this challenge but no products have previously been cleared by the FDA for aiding in the measurement of adherence until now.
“We are delighted that our collaborative work with the FDA continues to enable positive progress,” said Proteus Co-Founder and Chief Medical Officer Dr. George Savage. “We believe that ingestible devices have the potential to speed clinical trials and improve the real-world effectiveness of medicines in community settings.”
When used with a medication, the Proteus Ingestible Sensor marks actual intake time, a quantifiable event that has allowed regulators to grant the expanded indication to the company. The Ingestible Sensor was approved by the FDA in 2012 and communicates with an adhesive patch, worn on the torso. The Proteus Patch records time of ingestion along with steps, rest and heart rate, and communicates to a mobile app via Bluetooth.
As many players enter the wearables space, Proteus Digital Health is leading a new ingestible category in order to derive unprecedented insights about medication-taking behavior and physiologic response to therapy. Proteus is the only company that combines ingestible, wearable, mobile and cloud computing.
About Proteus Digital Health®
Proteus is creating a new category of therapy: Digital Medicines. Digital Medicine therapy includes drugs that communicate when they’ve been taken, wearable sensors that capture physiologic response, applications that support patient self-care and physician decision making, and data analytics to serve the needs of doctors and health systems. The goal of Digital Medicines is to empower patients and their families, enable physicians and health systems to more effectively manage risk and ensure that outcomes are reliably achieved.
Proteus received FDA market clearance in the United States and a CE mark in Europe for its wearable and Ingestible Sensor devices. 

Thursday, July 2, 2015

A Review of the midyear progress of mHealth

A Review of the midyear progress of mHealth focuses on several mHealth IPOs,  specifically Fitbit and Teladoc.

They serve two separate niches, fitbit in the area of mhealth wearables, and Teladoc as a provider-patient centered application allowing remote video patient encounters with physicians.

Several transformative shifts are occuring between mHealth and EHR integration. In some cases mHealth is driving EHR integration.

Our blog today offers a quick centralized source for progress in mHealth application development.

Will mHealth's rise signal the end of the EMR?

 EHRs and wearables - their time has come?]

The convergence of two industry titans, Apple and Epic portends another swift sea-change fueled by adequate capitalization of IPOs and equity funding. Does this mean the EMR is becoming obsolete? Or is it evolving into an EHR?
Much of the conversation between a doctor and a patient focuses on what the patient is doing outside of the doctor's office – in other words, the doctor is looking for data that today's health and fitness wearables are collecting. This means that all that information in the margins is now being pulled into the record.
Providers say they don't want all that extra information coming into the medical record, but they can't deny the value of health and wellness data in developing a care management plan for their patients. They're worried about validity – is data entered by the patient reliable enough to be included in clinical decision support?

At this point, the answer is no, and mHealth vendors and EMR providers understand this. As Navani points out, the data has to be curated first – collected, sifted and organized into something that a provider can trust and ultimately use. Some EMR companies tackle this issue by shunting consumer-entered data into a PHR or similar silo; the consumer then grants permission to the provider to parse over that data and determine what can be pulled out and ultimately entered into the medical record.
f that's the case, then this truly is a health record, not a medical record.
The proliferation of consumer-facing apps and devices has also given rise to a dichotomy in how mHealth data is collected. On one side stand platforms like Apple's HealthKit and ResearchKit, which gather consumer data for use by healthcare providers. On the other side are platforms like Qualcomm Life's 2net hub, which takes data from reliable devices – not the consumer – and goes to great lengths to ensure that such data is "medical grade."

Can both data streams share space in the same record? That depends on how EMRs and EHRs are defined.

EHRs and Medical Students: How to educate Medical Students

Practicing medicine today means interacting not just with patients, but also with computers. As of 2013, nearly 80% of office-based physicians were using electronic health records. But medical schools have been slow to keep up with the trend. There's no national standard yet for how med students should be trained on EHRs. Some are using computer systems from day one of their education. While others may be forced to sink or swim once they start to practice. This is a report for iHealthBeat, a daily news service of the California HealthCare Foundation.

<Audio Transcript>

I'm Ali Budner Priyanka Chilakamarri is a fourth-year medical student at the University of Vermont. From very early on, she and her fellow students were expected to engage with their lessons through computer screens. (Chilakamarri): "When I first started medical school ... they gave all the students laptops." They also immediately started using computers in their interactions with patients. That meant learning how to use an EHR system. But EHRs are complex and notoriously hard to teach. (Jemison): "Because inevitably the computers are attached to walls, your back is to a patient, there's a lot of physical reconfiguring you have to do in order to take notes." Jill Jemison is the director of technology services at UVM, Chilakamarri's school. (Jemison): "We're teaching them how to do a good note, how to put all the information in it, how to collect the right thing." The third year of med school is when students would typically be exposed to EHRs, when they start clinical rotations. But in her very first year at UVM, Chilakamarri was already practicing on what's called a "dummy EHR," a system that's been stripped of identifying personal information to protect patient privacy.


Harold Lehmann
Consider constructing a curriculum around a virtual (or multiple virtual patients). Cases should be created in the training environment, not only for the purpose of training in the use of the EHR per se, but also for teaching how to practice medicine in this machine-centric environment. Hopefully, one can teach how to be efficient, yes, but also, how to *think* in multiple screens that are not designed necessarily to aid cognition.
Lauren La Barge
Many of my friends and colleagues are medical students, and I was fortunate to live with many medical students at a top ranked institution. They are interested in curious about EHRs generally, but lose interest as they are unable to interact with them. Suddenly when they are in a clinical setting using EHRs for the first time, there is a lot of frustration and confusion. My friend, a first year anesthesia resident, used to take hours of work home on Epic! Teaching EHR use in the medical curriculum needs to be a part of the medical school experience.
Michael Warner
Medical students are in a tough position today as they are hands-off when it comes to the EHR. I was not allowed to write in the chart either, when I was a nurse's aid. I realize the legal ramifications, but patients are now able to view their records on patient portals and enter information. Why not allow the student doctor to partner with the patients and construct the History component of the encounter note? In research study that just concluded, patients where able to "co-author" their health record by writing a Pre-History. Imagine if medical student partnered with a patient to document her or her story? This might lead to a future where patients and providers get closer - while using the EHR as a tool.

July 2, 2015
Gary Levin M.D.
The clinical practice of medicine is changing rapidly. Advances in basic and clinical science challenge praactitioners as well as neophyte trainees. Today a new curriculum is developing in medical school focused on health information technology. Electronc health records and eRX are just two of the niches.

Today pre- medical students have a computer, pc tablet or are given one when they enter medical school. Much of the curriculum and even examinations are offered via this tool. Medical students enter school with considerable exposure to computer technology and operating systems.  They are facile with the hardware.  This is not so for EHR software.

Some thought is being given to  training students to use EHRs. However hospitals, and clinics may use different EHRs, and training students to use one does not necessarily translate to using another one.  In fact studies have shown it is easier to teach a student an  EHR if they have never used one.  Changing EHRs requires unlearning the original EHR to use the new EHR.

In general it may be more important to teach  adaptive skills, such as where to place a computer monitor or keyboard to minimize visual isolation from a patient. Digital health space believes that tablet PCs are the most user-friendly in the clinical environment.  It can be used much like a classical paper progress note... The addition of touch screen functionality is even more useful.

Sunday, June 28, 2015

E-value Mobile Health Education Curriculum Accreditation Management Clinical CompetencyCl

For those of you who have, or are discovering the  wealth of health apps available, not just for EHR or patient care we are publishing this special edition of Digital Health Space.

The title covers a swath of applications which may be unknown to  conventional practitioners and even some academicians.

1. E-value
2. Mobile Health
3. Health Education
4. Curriculum
5. Accreditation Management
6. Clinical competency logging

E*VALUE is a cloud based service (SAAS), which offers multiple solutions for users as needed.

Optimized Scheduling

Clinical Solutions

Teaching Solutions

Accreditation Solutions

     NAS & Milestones

     GME Insight

   Features of GME Insight Include: 
  • Milestones Reporting
  • Specialty-specific and sub-competency content
  • NAS-Related Program Indicators
  • Program-Level Dashboards and GME-Level Dashboards
  • Support for Annual webADS Reporting
  • Secure Data
  • PubMed Interface
    Allows students, faculty and administrators to retrieve, review and save PubMed articles without leaving E*Value.
  • Accessible From Any Device With Internet Access
    Teaching Solutions  (Video)

Empowering the Patient

New business models for pharmaceutical and medical device companies

Mobility is a key factor for staying in the game. This applies to providers as well.

How interoperability impacts the pace of mHealth adoption

Intelligent healthcare and the power of mHealth (Video)

Patients, health insurers, pharmaceutical companies, medical device manufacturers, hospitals are all adopting to the new 'mobile health paradigm.  Providers seem to be the last group to sign on

Wednesday, June 24, 2015

A New Wearable From Google Detects Diseases Prior To Patient Showing Symptoms | Techaeris

A New Wearable From Google Detects Diseases Prior To Patient Showing Symptoms

A New Wearable From Google Detects Diseases Prior To Patient Showing Symptoms | Techaeris

"Android Wear taking the Android world by storm, Google is working on bringing more functionality to wearables. However, instead of just keeping focus on the consumer line, the search giant is working another kind of secret wearable. This one is created by Google’s experimental Google X division and puts the entire focus on health tracking.
Like consumer devices, this secret wearable is not only able to take your pulse and heart rhythm but can also monitor your skin temperature continuously. Other things the device measures are light exposure and noise level. The search giant says the device is a lot more powerful than those tracking capabilities in current Android Wear devices.
The wearable isn’t the most attractive device and looks much closer to that of a Fitbit, and it’s capable of transmitting the monitored health data to the wearer’s doctor. It’s unclear what kind of software Google wants to use but the software is said to be easy to navigate.
The device is currently geared toward clinical trials and drug tests with the eventual hopes that it could give doctors an opportunity to monitor a patient of theirs at all times without requiring a hospital stay. There’s an eventual hope that the wearable could be worn by anyone and it could catch and prevent diseases before patients show any symptoms. In an interview with Bloomberg, Android Conrad of the life sciences team within the Google X division sees a bright future for the product.
“I envision a day, in 20 or 30 years, where physicians give it to all patients,” he said. “Prevention means all the time.”
Google will work with researchers and pharmaceutical firms throughout the summer to test the device and push for legal clearance in both the U.S. and Europe. From there, it will be used in official trials and tests. Don’t line-up for the hot, new wearable just yet, because while there’s plenty of excitement on the immediate horizon,  general availability appears to be a few years off."
Digital Health Space:  Opinion
The advantage for this health application is that the user normally wears a watch. This does not require any additional attachments for monitoring. It could be designed as a senior 911 alert, monitor blood sugar, Blood Pressure monitor, and use bluetooth for other purposes.

HIE and the 'learning healthcare system'

The notion of “health information exchange” has 
been around for decades, and we have tried many approaches. Yet our healthcare system is struggling to foster the kind of exchange that will truly drive better care and smarter spending. Entrenched payment policies that do not reward better health outcomes or coordinated care continue to hold us back. We are making progress, but many healthcare organizations today still treat health data as a close-hold business asset, when it should be treated as a public good.
We know that consumers want health information technology. According to a nationwide survey released by the National Partnership in December, patients overwhelmingly believe that electronic health records are essential to making sure providers have timely access to information that can help avoid medical errors and repeat tests.1 Consumers also want and use online access to their own health information, largely through patient portals.(Please wait for re--direct) Almost nine in 10 patients who have such access use it, and it has a significantly positive impact on patient engagement, better care and improved outcomes. Notably, individuals who use patient portals with some frequency are dramatically more likely to say it motivates them to improve their health. 


We also know that the role of consumers in healthcare is changing rapidly, facilitated in part by these emerging technologies, along with evolving economic incentives and rising consumer expectations.                               
These forces are converging, positioning consumers as a potentially potent force for change that can dramatically reshape the way we share and use information in healthcare—if we can make the process of downloading, managing and sharing health information easy, private and secure.
What does it take to unleash this consumer potential? Let’s look at how our system works today. In my case, I have a primary care physician who uses an EHR. I also have a high-deductible health plan, which means that I often seek out care from places that have published price lists and are convenient—like a web-based service that, earlier this year, allowed me to “see” a doctor online on a Sunday morning for just $49. As a result, healthcare data about me exists in several different places—with my doctors, my health insurer, MinuteClinic, my web-based doctor service, and more. This is not usual for most Americans. All of us have data spread across a patchwork of providers and systems.
But few if any of these systems talk to each other, which means that no single provider can see a complete picture of my care. So how can I, and the millions of consumers like me, become a force for change that drives health information exchange in the marketplace?
If I could gather my data electronically from all of the healthcare entities that hold it, and use a safe and secure app to store it, then I could share it with any one of my healthcare providers, giving them a much better view of my health and my care.       
The fact is, as the patient, I am the only one present at all of my healthcare encounters. So I can potentially amass more data, more quickly and more comprehensively than any single health care entity can today, because I know where it all is. And, in theory, I know how to get it. If I have the data, I can spot errors, avoid repeat tests, detect fraud, help facilitate coordinated care, and much more. I can be the curator of my own health record, sharing it where and when it is needed to improve my care, and for other important purposes like research into precision medicine.
We are close to achieving this vision; both the policies and the technologies exist. But we aren’t there yet. I learned this the hard way when I requested my data from my PCP eight weeks ago. Because the practice participates in Meaningful Use, I should have been able to download my data directly from the patient portal. That is due to an important federal requirement that stipulates patients must be offered online access to view, download or transmit their health information to a third party. Unfortunately, the patient portal was broken and the practice had no plan to fix it.
So I decided on another approach that few consumers—and it turns out, few providers—know about. Under the HIPAA amendments made by the HITECH law, I now have a legal right to an electronic copy of my health information. I can exercise this right with any covered entity that holds data about me, as long as they can produce the data electronically. And if they have a Meaningful Use-certified EHR, they can. So I asked my PCP’s office for an electronic copy of my health record.
After convincing them that I wasn’t trying to change doctors and just wanted my record electronically, they told me they “don’t do that;” they only offer paper copies. I told them about my legal right to an electronic copy since they have a certified EHR, and they again simply said they don’t do that.

So I returned a few days later with a copy of the Federal Register, demonstrating my legal right under HIPAA to an electronic copy. Over the course the following week, and many phone calls back and forth, the practice staff figured out how to meet my request. They created a text file, and a second file in a format called CCR, which stands for Continuity of Care Record, and placed both files on a CD-ROM that they left at the front desk for me to pick up.   
I quickly learned that having my record on a CD-ROM wasn’t very useful. I could read the text file (once I bought an external CD-ROM drive), but text files aren’t very actionable. So I did what anyone would when faced with a problem: I downloaded an app. The app used the CCR file to summarize and display my medical record in an organized way that I can understand.

The app is available on the Google Play Store  or iTunes

This simple medical records request was a big hassle—it caused a lot of friction even though I was simply requesting information to which I am legally entitled—information that is an essential part of my health and care. It required multiple trips to the doctor, several aggravating phone calls, legal and technical knowledge, and persistence. Most consumers won’t have the resources to persist and eventually succeed.       
These are challenges, to be sure, but they can be addressed in the very near term. And if we overcome them, the potential of consumers to unravel the knot that binds our health data in silos is enormous. If consumers can make a concentrated tug on the rope and demand their data, starting right now, it can enable systemic change.
To do that, we need to take the friction out of the process for consumers. There are a range of actions we can take in three broad areas over the next 24 months to achieve     change. The good news is that none require legislation. They can all be done by administrative action, by the private sector or with public-private collaboration. However, a little nudge from Congress can help:
1. Equip consumers with the tools and awareness they need to exercise their rights to their digital health data.
Make the process of requesting data easier. How can we automate it? A small group of leading experts, consumer advocates and former policymakers are catalyzing action in this area right now. Developers are working on tools such as the Vocatus tool, which enables consumers to request their health data online. Others are working to fix problems with patient portal download features.
2. Give providers the tools and incentives to make consumer use of digital data the norm in healthcare.    
Work through HHS to educate providers about how to meet the demand for digital health information—through patient portals and through other means of downloading data such as Blue Button (which Medicare and the Veterans Administration already use), or the Direct protocol—a secure email link between patients and providers. Use the federal EHR certification program to create the capacity for EHRs to incorporate consumer-generated data and make it easy for providers to analyze and act on.
3. Advance federal policies that enable consumers to routinely request, download and use their own health data in private, secure and valuable ways.
Finalizing the proposal to include open Application Programming Interfaces (APIs) in the federal EHR Certification program. APIs will help break down information silos in healthcare. Preserving and strengthening the Meaningful Use view/download/transmit requirement, most commonly met by offering patient portals which deliver functions patients want like secure messaging with their providers, online medication refills and data downloads. We must preserve both the requirement that the technology is in place, and the requirement that a percentage of patients use it at least one time during the reporting period. Regardless of whether the number is five percent or something else, CMS’s recent proposal to drop this threshold to just a single patient will completely undermine efforts by consumers who want to have and use their data. Requiring providers to actively engage with a percentage of patients is an essential mechanism for changing consumer expectations and enabling consumers as a force for change.

Christine Bechtel is an advisor for the National Partnership for Women & Families, president of Bechtel Health, and chair of the Consumer Work Group of the Health IT Policy Committee. This was adapted from her testimony before the Senate Committee on Health, Education, Labor and Pensions on June 10, 2015.