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  • Copy and paste: is it the big risk for EHRs?

    When patients visit their doctors, do they think that their doctors listen to the concerns and review the specific signs and symptoms of each patient and record them in unique notes, or do doctors categorise them and save time by copying and pasting text to record typical complaints and treatment plans? If the treatment options are limited, is it reasonable to expect that signs, symptoms and diagnoses are in a narrow band too? Either way, copying and pasting brings with it increased security risks.

    In the USA, the Department of Health and Human Services’ Office of Inspector General has reviewed these practices in the Centers for Medicare & Medicaid Services (CMS) and produced CMS and its Contractors Have Adopted few Program Integrity Practices to Address Vulnerabilities in EHRs. It found that:

    EHRs can make it easier to commit fraud such as using some EHR to conceal true authorship of medical records and distort information to inflate health care claims The transition from paper records to EHRs may present new vulnerabilities and require the CMS and its contractors to modify their techniques for identifying improper payments and investigating fraud CMS and its contractors had adopted few program integrity practices specifically for EHRs Few contractors were reviewing EHRs differently from paper medical records Not all contractors said they could determine whether a provider had copied language or over-documented in a medical record CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.

    Over-documentation is a USA term meaning inserting false or irrelevant documentation to create the appearance of support for billing higher-level services than provided. Identifying over-documentation increased from 78% to 83% with EHRs. Identifying copied language with EHRs dropped from 61% to 50%.

    Of the contractors, 22% conducted additional reviews. About 17% used data from audit logs.

    The report recommends that CMS should:

    Compile and provide guidance to its contractors on detecting fraud in EHRs Work with contractors to identify best practices and develop guidance and tools for detecting fraud in EHRs Direct its contractors to use providers’ audit logs.

    As African countries introduce and expand their use of EHRs and related eHealth, it’s a good idea not to switch paper-based practices into them without a thorough, rigorous review of their use and implications.

  • Avoiding risks is sometimes elementary

    Risk, red faces and costs often go together. A constructive reaction when it happens to someone else is to use it to reduce the chances of it happening to you. In France, the railway system has revealed an elementary, high cost measurement mistake. The Société Nationale des Chemins de fer Français (SNCF), the French train operator, has bought a new set of trains, the Regiolis Regional Express Train (TER). It then discovered that some of the platform edges are too close to the tracks, so the TER can’t enter these stations.

    It seems that Réseau Ferré de France (RFF), the national rail operator, provided SNCF the wrong dimensions. It measured comparatively new platforms built less than 30 years ago, but many regional platforms are older, and built when trains were narrower. The estimated correction costs are at least 15bn euros, or US$20.5bn.

    At least all the stations are in France. In 1816, the USA accidentally started to build Fort Montgomery in Canada because of an error in aligning the 45th parallel.

    Samuel Marx, nicknamed Frenchie, and father of the Marx Brothers, was a tailor. He guessed his customers’ sizes instead of measuring them. When they returned to collect them, they usually didn’t fit, so he started again. After he’d accumulated enough rejected suits, he took the bundle to sell them door-to-door. This isn’t a good way to set eHealth requirements and specifications.

    African countries can’t afford to fix resources on these large scales or deal with smaller scale disruptions. A simple lesson to mitigate risk is when the correction or disruption costs are high, rigorously check the data and the methodology. It applies to all eHealth design decisions.

  • Africa’s new ICT strategy’s completed

    This month Africa finalised a continental strategy to guide ICT development over the next decade. It’s a bold step forward and a culmination of extensive stakeholder engagement across the vast continent.

    The 5th Meeting of the Heads ICT Units in AUC, NEPAD Agency, Regional Economic Communities (RECs) and Associations of Regulators on Harmonisation and Coordination of Regional and Continental ICT Programmes, Projects, and Activities has ended with the adoption of the comprehensive Continental ICT Strategy for Africa (CISA).

    The strategy is anchored on 7 Strategic themes:

    Post and Telecom Infrastructure Capacity Development e-Applications and Services Enabling environment and governance Mobilisation of resources and partnerships Industrialization Research and development.

    The meeting was attended by representatives from the African Union Commission (AUC) , NEPAD Agency (NPCA), United Nations Economic Commission for Africa (UNECA), Southern African Development Community (SADC), Economic Community of Central Africa States (ECCAS), Economic Community of West African States (ECOWAS), East African Community (EAC), Inter-Governmental Authority on Development (IGAD), East Africa Communications Organizations (EACO) and the Communications Regulatory Association of Southern Africa (CRASA).

    The adoption of the new strategy has been deemed a “major achievement toward the harmonization of policies and regulations in Africa”  by Dr. Elham Ibrahim Commissioner for Infrastructure and Energy.

  • Google glass reviewer doesn’t like it

    The BBC’s technology correspondent Rory Cellan-Jones, has worn Google Glass for six weeks. His verdict is that he thinks it’s a failure. He says “sadly my verdict is that, in its present form with its current software, Google Glass is a failure. A fascinating, promising, sometimes brilliant product – but a failure nonetheless.”

    He goes on to say that “the voice control is very good for simple commands (“Ok Glass, take a picture”) but pretty useless for anything longer or more testing such as a search or adding a caption to a tweet. Part of the problem is that Google doesn’t seem to understand my British English.” Many of us have had similar problems with voice recognition generally, so Google Glass may be no different.

    His Google Glass wearing experiences haven’t dented his enthusiasm for wearable computers. He’s still excited by their promise and convinced that they’ll go mainstream in the next five years. If that’s for rich countries, what can African countries plan on?

  • Will Big Data be bigger?

    Is analysing healthcare data about patients’ analytics or Big Data? Does it matter? The Wall Street Journal (WSJ) says that Big Data fits data from routine medical check-ups, so how can eHNA argue? It draws from several Big Data initiatives in the USA. A short summary of three Big Data examples in the WSJ is on the iHealthBeat site. They are:

    Boston Children’s Hospital researchers examined data from 71,776 patients with sore throats then designed a way to help decide whether patients should see a physician to receive strep throat tests Data collected during physician visits and prescription information from a large insurance plan found that patients with autoimmune diseases have a heightened risk of epilepsy Stanford researchers used data from paediatric patients’ EHRs to find a link between patients’ allergies and flare-ups of uveitis in individuals with juvenile arthritis.

    As these positive examples accumulate, the case for analytics and Big Data becomes increasingly irresistible. African countries can start their own Big Data and analytics trajectories now.

  • Latin-America’s first telemonitoring programme underway

    Hospital Italiano in Buenos Aires, Argentina is home to a host of impressive projects. Amongst these is its claim to be Latin America’s first in-home telemedicine programme. In collaboration with telecom provider Telefonica de Argentina, Hospital Italiano’s medical informatics team has launched a pilot project where chronically ill patients receive a home telemedicine kit that will transmit health information directly to their electronic health record. The updates are also immediately available for physicians to use and analyse at the hospital.

    “The system, which works straight out of the box with virtually no user setup, consists of a tablet and various sensors which connect to it via Bluetooth,” explains project leader Dr. Fernando Plazzotta. These sensors include a digital scale, pulse oximeter, and blood pressure cuff, with the potential integration of other devices, such as glucometers for diabetic patients.

    “We are very excited to receive the feedback of patients and physicians alike,” says Dr. Plazzotta. He hopes that the positive results from the pilot will enable a transition into a full telemonitoring programme, which can be expanded in scope and volume.

    The well-executed principles of simplicity, ease-of-use, and user friendly interface make this a promising pilot, with valuable lessons for similar systems for Africa.