EHR, Cyber-attacks, Genomic Databases and much more

ONC: Rate of EHR Replacements Among Providers Up Significantly New data show that the percentage of eligible professionals and hospitals that switched electronic health record vendors quadrupled between meaningful use program years 2013 and 2014. Meanwhile, Texas has made $15.3 million in incorrect EHR incentive payments under the Medicaid meaningful use program.Health Data Management et al.

Latest Cyberattack Affects at Least 10M; UCLA Wins Data Breach Case   New York-based insurer Excellus BlueCross BlueShield has disclosed a cyberattack that could have compromised the personal records of more than 10 million individuals. Meanwhile, a California judge ruled that UCLA Health is not responsible for the unapproved release of a woman's medical records. Health Data Managementet al.

HIMSS Releases Top Health IT Policy Priorities for Congress The Healthcare Information and Management Systems Society has published its annual "congressional asks," naming interoperability, cybersecurity and telehealth as the top policy priorities that lawmakers should address in the next year. Healthcare IT News,Politico's "Morning eHealth."

Researchers Build Genomic Database To Analyze Millions of Genetic Variants   A team of researchers at the Broad Institute of MIT and Harvard is using data analytics to identify millions of genetic variants in the human exome, which is the 1% of the genome that codes for proteins. The researchers say such analysis could help improve diagnoses for individuals with complex conditions. The Atlantic.  c

Mobile Healthcare Transformation | AirStrip

Creative  innovation with style.  Apple watch OS enables remote monitoring on the wrist.

Unleashing Care Collaboration

AirStrip ONE® enables connections across the continuum of care, fostering active engagement and communication among caregivers, no matter where they are.

Helping advance collaboration and improve outcomes

AirStrip® helps clinicians and care team members stay ahead of the curve. Our FDA-cleared, enterprise mobility solutions bring live, diagnostic-quality clinical data right to a variety of mobile and fixed devices, empowering clinicians to:

• Expedite decision-making by enabling them to access, interpret, and respond to clinically relevant patient health data rapidly—anytime, anywhere
• Improve quality of care by dramatically enhancing their ability to assess, monitor, and direct care for every patient
• Facilitate collaboration and care coordination across the continuum of care—from outpatient and inpatient to community, clinic, and home
• Increase flexibility, efficiency and accountability by enabling connectivity with patients and members of the care team at any time, no matter where they are

Healthcare Without Boundaries

AirStrip® improves healthcare delivery with mobile interoperability solutions that unite clinicians and patients across geographic, technology and workflow boundaries. Our solutions provide the engagement, collaboration and insight caregivers and health systems need to provide patient-centered care—anytime, anywhere.

Turnkey interoperability that unlocks the value of existing infrastructure

AirStrip® can make true healthcare interoperability a reality. Our comprehensive enterprise solution provides the services, architecture, platform, and user experience that can enable IT to:

• Eliminate barriers between disparate data sources with a vendor-neutral, data source-agnostic platform that brings it all together
• Deliver a superior experience with native mobile architecture and elegant, simple solutions that tap the full potential of mobile operating systems
• Maintain the security of personal health information and help ensure compliance with HIPAA regulations and health system policies
• Reduce the burden on your IT organization with expert implementation services, AirStrip operations, and a flexible technology platform that enables rapid, scalable integration with your IT infrastructure

Helping health systems meet their strategic challenges

AirStrip® helps health systems innovate while allowing them to efficiently manage operating budgets. Our FDA-cleared, enterprise interoperability solutions provide a crucial strategic asset for realizing your most pressing goals. AirStrip solutions and services can enable healthcare executives to:

• Maximize the value of existing infrastructure – mobilizing data from multiple systems to support analytics and improved workflows
• Reduce care delivery costs while improving the patient experience and outcomes through more proactive and better-coordinated care
• Optimize workflows across the healthcare enterprise at every step of the care continuum, from outpatient and inpatient to community, clinic, and home
• Improve financial performance and accelerate ROI by expanding capacity and access to care, and opening the door to new revenue opportunities
• Mitigate risk by improving quality of care and patient safety, reducing readmissions, and supporting accountable care initiatives
• Attract top talent by offering clinicians the most advanced mobile care environment, maximizing clinician satisfaction
• Support financial, operational, and clinical initiatives in a variety of fee-for-service and value-based care model environments

Mobile Healthcare Transformation | AirStrip

Four State Medicaid Programs Will Not Transition to ICD-10 by Oct. 1 - iHealthBeat

However, CMS will allow four states -- California, Louisiana, Maryland and Montana -- to use a "crosswalk" technique to continue using the older code sets for their Medicaid fee-for-service programs because their claims processing systems in these four states are unable to use the new ICD-10 codes.

What is good for the goose may not be good for the gander.

Even as CMS and HHS insist upon implementation of ICD-10 some state agencies will be unable to comply when the conversion date from ICD9 to ICD10 magically occurs throughout the rest of healthcare.

What is the reason, and how does it differ from the rest of  healthcare providers,hospitals, clinics, and individual physicians, who have struggled at great expense to meet the mandates of HHS and CMS.

Four state Medicaid programs have received CMS approval to delay fully transitioning to ICD-10 code sets by the Oct. 1 deadline to do so, Modern Healthcarereports.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and procedures.

According to Modern Healthcare, all HIPAA-covered entities are required to complete the transition.

Details of Technique

How will this be accomplished for these government entities?   Under the crosswalk technique, the Medicaid programs will convert claims using the ICD-10 system into ICD-9 codes to calculate payments.

CMS spokesperson Jibril Boykin said, "We have worked closely with each state to understand how they will mitigate any issues that may arise and minimize impact on the accuracy and timeliness of provider payments." However, he noted that the crosswalk technique is not "a long-term approach."

California Department of Health Care Services spokesperson Adam Weintraub said CMS allowed the state's use of the crosswalk technique when it approved funding for Xerox Health Systems' upgrade of California's Medi-Cal management information system. Xerox's proposal included using a coding crosswalk. The system was implemented in September 2014 and is still undergoing external testing.

Government HIT is even more obsolete than private legacy systems. Many must be replaced rather than patched. However given budgetary constraints, this will not occur for some time.   Weintraub said, "California is working on a (claims processing) system replacement effort which, upon implementation, will process natively using ICD-10," adding, "As an interim solution, Medi-Cal implemented ICD-10 on our legacy system utilizing a crosswalk in order to reduce the cost and system changes to an aging system that is being replaced."

California Hospital Association spokesperson Jan Emerson-Shea said, "We do continue to have some concerns about the use of the crosswalk approach and we'll be raising these concerns during a stakeholder meeting."

Andrew Boyd, assistant professor in biomedical and health information sciences at the University of Illinois-Chicago, said, "My biggest concern is delay of payment for hospitals and physician groups, because cross-mapping could result in a cash flow crunch on already narrow margin groups."

Meanwhile, Robert Tennant -- director of Health IT Policy at the Medical Group Management Association, which has sought to delay the transition to ICD-10 -- raised concerns about such readiness issues surfacing this close to the compliance date (Conn, Modern Healthcare, 9/4).

57% of Health Care Groups Not On Track for ICD-10, Survey Finds

Survey: Just 10% of Texas Doctors Confident About ICD-10 Transition    

Just 10% of Texas physicians said they are "very confident" their practices will be ready for the upcoming ICD-10 transition, according to a survey by the Texas Medical Association, Health Data Managementreports.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and procedures.

The survey, conducted in July, included responses from 936 TMA members and non-members, 42% of whom were solo practitioners.

Survey Findings

According to the survey, just 7% of physicians said they have started transitioning to ICD-10 extensively (Slabodkin, Health Data Management, 8/21). Meanwhile, 31% of respondents said they had not started the transition at all (Bresnick, EHR Intelligence, 8/19).

Among solo physicians, 82% said they have not started the transition at all or have made only limited progress (Health Data Management, 8/21).

Meanwhile, 42% of respondents said they are "not at all confident" that the implementation of ICD-10 will cause no serious disruptions (EHR Intelligence, 8/19).

For example, the survey found that:

• 83% of respondents expect the transition to result in delayed or denied claims;
• 36% expect to face disruptions that require them to draw from personal funds;
• 32% said they might reduce staff size, work hours or benefits; and
• 30% said they might retire early because of anticipated cash-flow issues related to the transition (Health Data Management, 8/21).

Further, the survey found that:

• 47% of administrative staff at primary care organizations and 40% of primary care physicians have participated in education or training related to the transition; and
• 33% of solo practitioners have received ICD-10 training or education.

Among respondents with electronic health record systems in place:

• 65% said they are capable of processing ICD-10 codes;
• 52% said their practice management software was capable of processing ICD-10 codes ; and
• 1% said they will need to completely replace their IT systems to comply with ICD-10.

Meanwhile, 29% of respondents without upgraded EHR software are expecting to implement new products soon (EHR Intelligence, 8/19).

Four State Medicaid Programs Will Not Transition to ICD-10 by Oct. 1 - iHealthBeat

The POLY[]PILL

Technology and the pressure of cost containment and improving patient compliance are resulting in an interest in developing a pill with 3,4, or even 5 drug combinations.  There are however some obstacles for this advance in poly-pharmacology.


Patients often are not compliant with treatment recommendations, even for one medication.  As more medications are prescribed compliance deteriorates further.

If a safe, inexpensive, once-a-day pill could substantially reduce the risk of myocardial infarction (MI) or stroke, would people want it? Most would probably say yes because MI and stroke are the first and third leading causes of death, respectively, in the United States.1 It is likely that many employers, health plans, and payers would also say yes because MI and stroke cost the US economy more than $300 billion annually in health care expenditures and lost productivity.2

Improving adherence by simplifying drug regimens and reducing their cost could have far-reaching consequences. In 2003, Wald and Law3 proposed to combine 3 half-dose antihypertensive agents, an intermediate-dose statin, low-dose aspirin, and folic acid into a once per day polypill for primary and secondary prevention of cardiovascular disease. Based on epidemiological models, they estimated that daily use by individuals aged 55 years or older could reduce the incidence of MI and stroke by more than 80%.3

The 4 drugs in the current version of the polypill have long histories of safe use. Although all 4 are frequently prescribed in the United States, the US Food and Drug Administration (FDA) has not approved combining them in a single pill. It has, however, authorized approximately 50 two-drug pills for hypertension.4 Recently, an FDA advisory committee expressed cautious support for using the polypill for secondary prevention of MI and stroke in patients who are unlikely to be closely monitored by a physician. It did not address the larger question of primary prevention.5

Although the polypill could produce substantial public health benefits, people in the United States are unlikely to find out anytime soon. This is because the pill’s price is so low (≤$1 per tablet) and the cost of the large clinical trials required for FDA approval is so high, it is unattractive to investors. The inventor’s dilemma is that creating a product that improves health is not enough; the product must also be able to generate a healthy return on investment. In the United States, the surest way to generate a healthy return on investment is to increase health care spending, not reduce it.

In reality advances in drug delivery systems will be very important for pubic health reasons, compliance and cost reduction.  It will require some creative and innovative for financing drug development costs.  The technology is ready, can we afford it ?  We need innovative venture capitalists.  It is doubtful whether the Affordable Care Act will nourish this embryonic technology.  What can be done?

First, to inspire innovators, federal agencies and philanthropies should commit a larger share of their research budgets to high-risk, high-reward science. Second, to entice inventors to address challenging problems, there could be greater use of prizes (eg, cash for the first inventor who creates a drug or device that meets a specific need).

Third, to ensure that low-cost, high-value discoveries reach the market, patent buyouts could be offered. This could increase the likelihood that these products are commercialized and offered at prices sufficiently low to encourage widespread adoption.

Fourth, to give inventors access to the capital required to bring a cost-lowering technology to market, a public-interest investment fund could be established. The public-interest investment fund would seek out promising products that are not attractive to conventional investors, and replenish its coffers with shared savings from successful inventions.

Fifth, to streamline the regulatory approval process, the FDA could be authorized to use existing mechanisms, such as fast-track or breakthrough therapy authority, to expedite review of cost-lowering technologies. This would require expanding the FDA’s mission beyond safety and efficacy to address costs.

What is the actual cost to develop a new medication ? The California Biomedical Research Association outlines the process

Surveys from different sources reveal estimates between $800 M and 5.0 B. That is a substantial range as reported by Tuft's

The studies are spread out from 2010 to 2015 and the increases have been substantial during this period. Keep in mind that reports from pharma are used to justify the high costs of drugs.

In addition the costs vary greatly among disease categories and the category of the drug.  Some drugs are a variation of one already approved, while others are in new classes such as oncology drugs designed as antibodies to cancer cells.  Variations in cost estimates suggest that policymakers should not use a single number to characterize drug costs. It is important to also be aware that different drug types might have substantially different actual costs of clinical trials. Therefore, the estimated variation in drug costs could be higher or lower, depending on whether the correlation between actual costs, success probabilities, and durations is positive or negative. As discussed below, recent work suggests that HIV/AIDS drugs have high clinical costs.


Poly drug combinations are made of already approved drugs for single use, and development costs may be far less. 





JAMA Network | JAMA | Effects of a Fixed-Dose Combination Strategy on Adherence and Risk Factors in Patients With or at High Risk of CVD:  The UMPIRE Randomized Clinical Trial