University of California Researchers Build Trial Blockchain Network For Sharing Clinical Data | Healthcare IT Today

Patient Directed Health Data Exchange on The Blockchain

This research is just one of a number of projects exploring blockchain-based health data management. Expect to see both commercial healthcare ventures and research organizations roll out new blockchain-based information sharing the next couple of years. For example, earlier this year a group including health insurers, a bank and IBM Corp. announced that it was building out a blockchain-based “ecosystem.” In addition, it’s likely that more organizations will pursue models that attempt to put the patient fully in charge of their health data, such as PatientDirected.io, a patient-directed health data exchange.

While the technical approach researchers took may have been successful, they admit that administrative drawbacks could make it hard to put into place in real-life conditions. “Forcing all participating parties to use a service like this will still remain a challenge,” they concede. 

The Patient Directed IO, the platform directed at the patient

The researchers also acknowledge that while blockchain can incorporate data into structures that are immutable, traceablem and verifiable, it can’t protect against falsified data being introduced at the point of origin. To address this concern, trial participants would ideally see that raw forms of data or input be captured as early as possible into the blockchain.  A trio of researchers with the University of California San Francisco have developed a blockchain-based model for sharing clinical trial data between institutions. Their model not only protects the data but also makes the data traceable and immutable, according to a paper they wrote describing their work.

The paper, which was published in the journal Nature, outlines how they built a proof-of-concept web portal service using data from a real completed clinical trial. It notes that at present there are many levels at which such data could be intentionally falsified or accumulate errors, and that it remains difficult to track and access data across the complex network of data partners often involved in such trials.

To see if they could address these issues, the researchers created a prototype phase II clinical trial which would register all participating parties in a portal based on a private blockchain. In this model, all parties would be required to use the portal for any and all information exchanged related to the trial.

HOW BLOCKCHAIN TECHNOLOGY WILL TRANSFORM HEALTHCARE IN 2019.    Several industries have already been completely disrupted by blockchain technologies.  p up. More and more, cryptocurrencies are being legalized –  

THE  FUTURE OF HEALTHCARE IS  EHEALTH  FIRST

At the beginning of 2017, a number of healthcare, blockchain and business professionals – researchers and physicians at the top of their fields – came together with an interesting idea. They knew, already, that lots of data was being collected. Patient records have been stored digitally by doctors for years, and a wealth of data, including medical research and information on patient outcomes, has already been gathered. This group of physicians realized right away that this data can be stored on distributed ledgers – on the blockchain – to keep it secure, but also accessible in such a way so as to make medical care more effective.

This group of physicians has gone one step further and has enlisted several top experts in computer science and robotics in doing so. This data, that has already been collected, and continues to be collected, could be processed using artificial intelligence algorithms, machine learning, and neural networks. A user – be it a medical professional or the patient itself – could potentially enter metrics regarding symptoms into the system to find a diagnosis, as well as the best possible solution to their problem.

Now, these medical and computing experts are ready to announce that they have begun work on a platform – eHealth First – that will allow users to do just that. EHF (www.ehfirst.io) consists of two applications. The first is a user-friendly mobile and web application that allows users to get diagnoses and recommendations that improve medical conditions and increase lifespans. The second is an open platform for medical professionals, that allows specialists to access medical research data in order to build other platforms specializing in a wide array of medical conditions and diagnoses.

Taking the eHealth First platform into consideration, as we move into 2018, it seems the blockchain will revolutionize healthcare in three ways:

Data Driven Health Care

Provide secure use of medical records which can be used for diagnosis by doctors or AI.

Medical professionals have been storing patient medical records digitally for two decades already. This data can be securely stored on a distributed ledger, all while maintaining patient privacy.With the help of advanced algorithms, this data is extremely valuable. These records show the symptoms that lead to a diagnosis, and then the treatments that worked, and the ones that didn’t. Apps are being developed that will allow symptoms, laboratory and instrumental indicators, as well as other data, to be entered as input, and for a diagnosis and treatment or prevention recommendation to be received as output.

University of California Researchers Build Trial Blockchain Network For Sharing Clinical Data | Healthcare IT Today: A trio of researchers with the University of California San Francisco have developed a blockchain-based model for sharing clinical trial data between

New Malpractice Risks in Your EHR

Malpractice liability risks for physicians, practices, and healthcare organizations (HCOs) continually change, owing to a variety of healthcare and technology issues. From changes in treatment and care strategies to the ability of your electronic health record (EHR) to support new patient service tactics and care responsibilities, you need to be aware of these risks. You also need to manage your EHR use to address potential malpractice-related risks.

On the plus side, as more patient care tools are built into EHRs and as more active patient care interventions become part of your patient treatment routine, EHRs may help you manage patients and your clinical activities.

However, built-in EHR features that display warnings and advisories can produce a cacophony of visual and auditory noise that can be distracting. Physicians need to be able to control and manage them. EHR-generated advisories that are misleading or inappropriate could disrupt patient service, confuse physicians, and undermine confidence in the EHR.

If a malpractice case arises, the plaintiff could see evidence that's residing within your EHR, and use it against you. For example, EHR drug interaction warnings as well as notifications of incoming secure messages are tracked and recorded by the EHR. Such information may be used for internal performance tracking, managing clinical operations, or to review how your practice or HCO responded to a patient issue, related to a malpractice claim.

Indeed, many plaintiffs home in on ineffective EHR use and incomplete information as a weapon to undermine the entire EHR-based patient record as well as the quality of care provided to the patient.

The most important defense and plaintiff tool is the EHR's audit trail.

If your practice or HCO is faced with a malpractice lawsuit, your EHR will be closely examined to identify the sequence of events recorded in the EHR. Sometimes this examination will show records of diligent patient care and services that will support defense of a claim. Unfortunately, many discovery processes uncover open care items, incomplete messages, unsigned notes, delayed clinical response, and other dangling issues that call into question what was done for the patient and when it was done.

Lower Malpractice Risk Through Video Visits (Telemedicine)

Telemedicine visits are conducted through a HIPAA security-compliant web meeting with a patient. A physician might conduct a video visit in response to a care management issue, receipt of the secure message from the patient portal, or scheduled in place of an office visit. Telemedicine visits may include use of web-enabled diagnostic tools, such as a spirometer and a blood pressure/pulse device.

To lower malpractice risk, the physician or practice must document the encounter on a timely basis and ensure that the instructions and recommendation to the patient are clearly conveyed and any follow-up issues addressed on a timely basis. Note that the patient may record the telemedicine visit. It may be a useful tool to encourage patient care and support the due diligence efforts of the physician or practice, as long as the telemedicine visit is properly structured and conducted to explicitly and clearly communicate the physician's decisions and recommendations.

Additional follow-up with patients on video visits may be a critical component to your patient service strategy that will also lessen the chance of any problems. For example, a recommendation to change medications during a video visit may trigger a follow-up call on the effect of the medication change through a care management arrangement.

EHR Modularization Presents New Lawsuit Threats

With several EHRs, the evolving patient care requirements, including care management and telemedicine, are addressed through interfaces to specialized software. Many EHRs have been interfaced with patient portal, care management, patient contact management, and diagnostic software. Interfaced products typically exchange a subset of information that is used to support the patient services but may complicate patient record-keeping and raise your malpractice liability risks.

To understand the complete situation, and also see the potential danger, a physician or staff may have to access several software systems. For example:

• Some EHR vendors use a third-party patient portal that maintains its own records of interactions with patients outside of the basic EHR. The patient portal interactions are not visible from the EHR view, and the physician may not get an accurate sense of the patient's evolving condition.
• Care management software may allow the user to create a report from the patient services, which is saved as an image on the EHR. The care management information may be reviewed through accessing the image, but the care management information will not be displayed in context with EHR-based activities, such as prescriptions issued or telemedicine information.

New Malpractice Risks in Your EHR: Working with an EHR can be difficult, but even worse, there are ways that your data input could work against you if a possible malpractice lawsuit arises.

The Oversell And Undersell Of Digital Health | Health Affairs

Millions and perhaps  billions of dollars are being spent on digital health applications, which include electronic health records, telemedicine, analytics, artificial intelligence, MIPS, MACRA, and more, without any real indication of improvements in quality of care, or a reduction in cost. In fact the cost of data entry decreases efficiency and increases cost for the time and personell to perform these duties.

Physicians  complain bitterly about electronic health records and attribute major burnout due to overwork and fatigue. The completion of data entry for EHR alone amounts to one to three hours/day,  which causes a decrease in patient volume, or an extension of a doctors work hours.

Digital health technologies hold great promise to solve some of the biggest problems in our healthcare system, including achieving higher quality, lower cost, and greater access to care. In the January 2019 issue of Health Affairs, we reported that scant evidence exists demonstrating the clinical impact of twenty top-funded digital health companies.

We found 104 peer-reviewed published studies on the products or services of these companies. The majority of the studies were from three companies. Nine companies had no peer-reviewed publications. Only 28% of the studies targeted patients with high-burden, high-cost conditions or risk factors. Healthy volunteers were the most commonly studied population. Further, 15% of all studies assessed the product’s “clinical effectiveness” and only eight studies assessed clinical effectiveness in a high-cost, high-burden population. The eight clinical effectiveness studies measured impact in terms of patient outcomes, while no studies measured impact in terms of cost or access to care. There were no clinical effectiveness studies in heart disease, COPD, mental health conditions, hyperglycemia, or low back pain. Studies that did not assess clinical effectiveness may have intended to validate the product against a gold standard measurement or report feasibility of use. 

This is of particular interest given the incredible amount of funding, interest, and hype in digital health. Although these companies were only a small portion of total digital health companies, they were a large portion of total private funding and had the most resources to demonstrate impact. Further, since “digital health” currently encompasses myriad technology types and approaches, these findings have broad implications.

Does this mean digital health is doomed? Should investors, consumers, patients, and developers stop spending their money on digital health? Do our results describe all digital health sectors and companies?

No. No. No.

The idea of a telemedicine visit between doctor and patient to foster more effective care is not new. The concept was first reported in the April 1924 edition of Radio News (Exhibit 2), making the cover of that issue. Although many centers practice telemedicine today, that vision developed in the 1920s is still not yet a fully deployed reality. 

Today, telemedicine visits are hyped as one of the healthcare approaches that could revolutionize vast areas of patient-provider encounters. Yet, even at the most prolific centers that perform telemedicine, it represents less than one percent of total care volume. The major leaps in how healthcare is delivered won’t occur with a great new idea or a remarkable advance in technological capabilities. Instead, the transformation will occur when an innovation is effectively integrated into complex environments with complex people.

To truly make a transformative impact on health care, we encourage digital health companies to begin with the standard of evidence of impact that physicians, hospitals, insurance plans, and patients seek: high quality studies of highly-burdened populations using rigorous study design in real clinical environments with meaningful metrics of impact - outcomes, cost, and access to care.

Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis.

The Oversell And Undersell Of Digital Health | Health Affairs

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