Blog from August, 2020

Christopher Jason


An increase in interoperability and access to patient data triggered an ePrescribing increase in 2019.


The introduction of ePrescribing in 2003 brought a more convenient, cheaper, and safer prescribing alternative for doctors, pharmacies, and patients.

“With electronic prescribing, or ‘e-Prescribing,’ health care providers can enter prescription information into a computer device – like a tablet, laptop, or desktop computer – and securely transmit the prescription to pharmacies using a special software program and connectivity to a transmission network,” according to The Office of the National Coordinator for Health Information Technology (ONC).

Once a pharmacy receives a request for a prescription, it can start filling the medication immediately.

Momentum began for ePrescribing when it was introduced in the Medicare Modernization Act (MMA) in 2003. It then became more prevalent, and it garnered more publicity when a July 2006 Institute of Medicine report said it reduced medical errors, which helped build further awareness of ePrescribing’s role in increasing patient safety.

According to CMS, adopting the standards to streamline ePrescribing is an essential government item to accelerate the adoption of EHRs and build a national health IT infrastructure in the US.

In short, an increase of ePrescribing aims to allow for improved workflow, increased patient safety, and more drug price transparency in the future.

In 2019, healthcare professionals saw the benefits of greater access to patient data information, according to a Surescripts 2019 National Progress Report. As a result of this access, ePrescribing rates increased between 2017 and 2019, alongside improved workflows, increased drug transparency, and increased automation.

EPRESCRIBING ADOPTION, USE TAKES OFF IN PROVIDER OFFICES

ePrescribing rates climbed from 1.49 billion in 2017, to 1.64 billion in 2018, to 1.79 billion in 2019. That brings the total rate of ePrescribing up from 66 percent of all prescriptions in 2017 to 80 percent of all drug prescriptions in 2019.

Clinicians used ePrescribing for both non-controlled and controlled substances at a higher rate in 2019 than the prior two years.

ePrescriptions for non-controlled substances are up from 76 percent in 2017 to 86 percent in 2019.

“With the COVID-19 pandemic impacting patients and providers across the globe, a trusted nationwide health information network has never been more critical,” Tom Skelton, chief executive officer of Surescripts, said in a statement.

USING EPRESCRIBING TO CURB THE OPIOID CRISIS

In response to the country’s opioid crisis, paper opioid prescribing rates have declined recently.

Opioid overdose rates have quadrupled between 1999 and 2015, meaning the opioid epidemic has shown no signs of slowing down.

What’s more, tracking appropriate opioid prescriptions — one of the primary drivers of the opioid epidemic — can be challenging.

In 2019, 13 states enacted e-prescribing requirements, meaning more than half of all states now require ePrescribing for opioids, all controlled substances, or all prescriptions. Also, more opioid prescriptions were written electronically, which helped protect patients against prescription fraud and abuse.

Since 2017, the number of ePrescriptions written for opioids increased 36 percent, from 33.2 million to 67.7 million.

Furthermore, the introduction and usage of Electronic Prescribing of Controlled Substance (EPCS) technology intended to help providers integrate opioid prescription information into EHRs, which can boost patient safety and help prevent diversion and fraud. ECPS technology can also streamline clinician workflow and reduce patient burden.

A 2019 study conducted by ONC found the number of clinicians that utilize EPCS increase 29 percentage points from 2015 to 2017 with the help of EPCS technology.

ONC found that only three percent of Medicare prescribers used EPCS in 2015, 11 percent in 2016, and then 32 percent in 2017. While the total EPCS use is still low, the increase is a step in the right direction.

Policymakers expect the use of EPCS technology to increase under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which they passed in 2018.

The bill would require clinicians to electronically prescribe Medicare Part D prescriptions of opioids and other controlled drugs by the start of 2021.

“The value of EPCS technology – streamlined prescriber workflow, improved medication safety, and reduced drug diversion and fraud – should be available to all clinicians,”  ONC doctors Andrew Gettinger, MD, and Thomas A. Mason, MD, said in a statement.

“We are also intrigued by the potential for EPCS technology to make prescriber identification both assured and easier. This can permit a single workflow for prescribing both controlled and non-controlled drugs, which can improve the usability of the current process. To that end, ONC will continue to work with our federal partners and clinical stakeholders to advance the adoption of EPCS technology.”

While the use of ePrescribing is currently ascending, this form of prescribing will allow for more drug price transparency, increased patient safety, and an improved workflow for clinicians in the future.






Jessica Kent


The team will leverage artificial intelligence to develop tests that can predict a severe illness linked to COVID-19 in children.


NIH is funding a project that will use artificial intelligence to identify children at risk of Multisystem Inflammatory Syndrome in Children (MIS-C), an illness believed to be a severe complication of COVID-19.

Most children exposed to COVID-19 develop only mild symptoms. However, some go on to develop MIS-C, a severe and sometimes fatal inflammation of the organs and tissues, including the heart, lungs, kidneys, eyes, brain, and skin. The new effort will aim to encourage studies of genetic, immune, viral, environmental, and other factors that influence the severity of COVID-19 cases and the chances of developing MIS-C.

NIH will award up to $20 million to successful research proposals over four years.

“We urgently need methods to distinguish children at high risk for MIS-C from those unlikely to experience major ill effects from the virus, so that we can develop early interventions to improve their outcomes, ” said Diana W. Bianchi, MD, director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The NICHD-led project, called Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence (PreVAIL kIds) is part of NIH’s Rapid Acceleration of Diagnostics (RADx) initiative. The RADx initiative seeks to speed innovation in the development, commercialization, and implementation of technologies for COVID-19 testing.

The effort is a national call for scientists and organizations to bring their innovative ideas for new COVID-19 testing approaches and strategies. Funded projects may also include new applications of existing technologies that make tests easier to use, easier to access, and more accurate.

“We expect that RADxUP will foster continued use of common data sets around the pandemic, and create a model about how this can be done well. The initiative can serve as a data resource that people can use for years going forward,” Lis Nielsen, PhD, director of the Division of Behavioral and Social Research at the National Institute on Aging (NIA), told HealthITAnalytics.com.

PreVAIL kIds will aim to encourage the development of cutting-edge approaches for understanding the underlying factors influencing the spectrum of conditions that may occur in children and youth infected with COVID-19. These range from no symptoms at all to fever and cough, abdominal pain and diarrhea, and inflammation of the coronary arteries. The goal of the initiative is to understand the range of symptoms of COVID-19 and factors leading to MIS-C.

Studies funded through the PreVAIL kIds will evaluate genes and other biomarkers in COVID-19 pediatric cases, as well as examine how the virus interacts with its host and how the immune system responds. Researchers will leverage artificial intelligence and machine learning to sort and categorize the data they acquire to understand the disease patterns they uncover.

The initiative will add to NIH’s many efforts to further combat and understand COVID-19 using innovative tools. The organization recently launched the Medical Imaging and Data Resource Center (MIDRC), which will use artificial intelligence and medical imaging to enhance COVID-19 detection and treatment.

The effort will be led by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), and will work to create new tools that physicians can use for personalized therapies for COVID-19 patients.

“This program is particularly exciting because it will give us new ways to rapidly turn scientific findings into practical imaging tools that benefit COVID-19 patients,” said Bruce J. Tromberg, PhD, NIBIB Director. “It unites leaders in medical imaging and artificial intelligence from academia, professional societies, industry, and government to take on this important challenge.”






Christopher Jason


The nation’s largest health information exchange has boosted its interoperability by enabling electronic case reporting.


eHealth Exchange, the nation’s largest health information exchange, launched COVID-19 electronic case reporting (eCR) in connection with the Association of Public Health Laboratories (APHL) and OCHIN to increase interoperability between providers and public health agencies.

eCR is the automated production and submission of reportable diseases and conditions from the EHR to public health agencies, according to the Center for Disease Control & Prevention. It also aims to address and reduce reporting burden.

eCR gathers data from APHL, the Council of State and Territorial Epidemiologists (CSTE), and the CDC. Each organization plays a role in facilitating eCR. Precisely, providers use eCR for reporting certain health conditions, as well as the public health agencies and vendors that enable eCR.

“The new electronic case reporting allows network participants to automatically report relevant health information to public health agencies via the eHealth Exchange,” Jay Nakashima, executive director of eHealth Exchange, said in a statement.

“We’ve been working hard with APHL to bring this to life and hope it eases the process for providers and health information networks reporting COVID-19 data and other reportable conditions to their local, state, and federal agencies.”

OCHIN, an Oregon-based nonprofit health information and innovation network that includes over 10,000 clinicians from across the country, is the first eHealth Exchange connection to utilize eCR across its network. According to OCHIN, it tapped eCR through eHealth Exchange due to the eCR requirements for communities that were severely impacted by COVID-19.

“The eHealth Exchange provided OCHIN a single API to securely channel disease notifications to local and state public health authorities all across the U.S.,” Paul Matthews, chief technology officer, and chief information security officer of OCHIN, said in a statement.

“So instead of building and maintaining these separate connections with countless public health authorities across the country, this allowed us to create efficiency in the reporting system and reduced the burden on providers in our network.”

More than 50 percent of the nation’s HIEs are connected to the eHealth Exchange network. Furthermore, 75 percent of all US hospitals, 61 regional or state HIEs, 70,000 medical groups, and over 8,000 pharmacies make up the nationwide exchange. In total, eHealth Exchange accounts for over 120 million patient records.

The eCR service will be provided to all Carequality-connected networks at no cost, to advance public health reporting, cited the organization. The HIE said the eCR platform would automatically generate and transfer COVID-19 case reports, and it will eventually have the capability to support the 50-plus diseases that APHL oversees.

“The eHealth Exchange has paved the way for seamless electronic case reporting via the Association of Public Health Laboratories AIMS platform,” John Loonsk, chief medical informatics officer of APHL, said in a statement.

“The policy and technical underpinnings of the eHealth Exchange allow healthcare organizations to provide critical clinical data to public health while practically reducing their reporting burden.”

New COVID-19 data protocols now call for situation awareness data to flow from the CDC to the US Department of Health and Human Services (HHS). However, situational awareness data differs from eCR data, which still transfers between state and local public health agencies.

While case reporting between state and local public health agencies is a requirement across the country, providers are facing a challenge with individual public health jurisdictions. The process is very localized, where counties do not want to work directly with the state. This means the CDC and the state have to be on the same page to streamline the process.





Eric Johnson


In 2009, the HITECH Act prompted hospitals and medical centers across the country to move patient information from paper health records to electronic versions. Electronic health records (EHRs) introduced a wave of new possibilities—like searching for information instantly, analyzing large trends and preventing data loss.

They also created a need for rigorous standards of privacy and security.

Historically, very few groups outside of health care have had a good reason to collect information about personal health—but the coronavirus changed that.

Suddenly, organizations all over the world are incentivized to understand this virus better, and many are going so far as to do their own research. Local governments are tracing symptoms, offices are asking their employees for temperature checks and companies are checking on customers.

As a survey company, SurveyMonkey has a front-row seat to what might be the second wave of change in the way we think about health care data.

The coronavirus has prompted a flood of demand for data insights

As businesses start to reopen, everyone from retail stores to big corporate offices need to understand whether they can safely go back to their offices and how their community is impacted. They too have started asking questions.

The result is a flood of new data points coming into all kinds of organizations—from health care to government to small businesses to international corporations.

Here are some examples of the types of data that I’m talking about.

  • The Rhode Island Department of Health created an opt-in survey program for patients who have tested positive for the virus to answer questions about how they are feeling. The goal is to track symptoms and understand how the illness progresses.
  • A U.N. organization and partners in South Africa created a self-assessment survey that people without access to a COVID-19 test can take to help self-diagnose. They will use the responses to determine where the country needs to add new facilities, and maybe even new hospitals.
  • A U.S. department store with almost 900 locations is asking employees whether they’ve been diagnosed with coronavirus and what their symptoms are.

Governments, NGOs and companies across the world are doing similar research, and many workplaces will start taking the temperature of every person who enters the building. There are far more health care data points in circulation than before, both publicly and privately.

So what are the implications of this?

First, the clear line between individual protected health information (PHI) and businesses that have nothing to do with health care could get blurrier. Second, we could unlock incredible new breakthroughs.

The importance of prioritizing privacy during the coronavirus

PHI is protected under HIPAA—which means that covered entities and business associates who collect it are liable if they fail to keep the information private and secure. Even if an organization’s intentions are noble, mishandling PHI would be an incredible breach of the trust of its employees or customers.

Violating HIPAA can result in significant fines and criminal penalties and could cost businesses their customers, their employees and their good reputation.

That isn’t to say that these organizations shouldn’t be asking questions or gathering other PHI (like taking temperatures)—in many cases, that may be the responsible thing to do. It just means that teams collecting it need to be careful.

In many cases, businesses already have resources to help people stay compliant from a behavior perspective, including legal teams and security and compliance groups. So whoever is thinking about collecting information that could fall under PHI—marketers, customer support, HR, etc.—will need to consult with those internal experts before they do so and keep them in the loop at every stage.

An area to be especially conscious of is information storage. Groups that collect PHI are also responsible for saving information in a secure place—including digitally—controlling the people who have access to it, and disposing of it securely when it’s no longer needed. HIPAA compliance obligations can often extend to vendors, integrations, and partners.

The urgency of the coronavirus might tempt businesses and other groups to move fast, but it’s equally important to be careful. If organizations plan to collect PHI to protect a community’s best interest, they need to extend that concern to the processes, staff and security of that data and protecting that data appropriately.

The potential benefits of the second wave of health care data

But the flood of new information could also lead to unprecedented insights.

Health care institutions are usually extremely cautious with medical data, including in research, which means less sharing. Many medical studies are restricted to the pool of volunteers within a certain institution or program, which ensures that the data collected is comprehensive and sound, but limits the scale.

This second wave of data involves much more information, coming from all kinds of different sources. Each of these also has its own pre-existing unique data sets. If organizations across regions and industries start collecting and sharing information about coronavirus symptoms and trends, what insights could that unlock?

Some of these changes may even outlast the coronavirus. It’s reasonable to assume that some might pay closer attention to health or continue to collect health-related information in the future. If that’s the case, then organizations should be planning for long-term security policies and sustainable solutions with the interests of their community (customers, employees, partners) front and center.

The world is experiencing a flood of new health information, and there are risks, responsibilities, and opportunities that come with that.





Jessica Kent


Howard University College of Medicine is partnering with AARP to improve chronic disease management using artificial intelligence and data analytics.

Howard University College of Medicine’s 1867 Health Innovations Project and AARP Innovation Labs will leverage artificial intelligence and data analytics to boost chronic disease management in medically underserved communities.

The partnership will examine age-tech solutions to expand healthcare access for people with chronic conditions, and will focus on developing new models of care.

AARP and Howard University will conduct two clinical pilot projects to improve diabetes management and medication adherence. The first is a proactive voice-technology that uses facial recognition to remind individuals to take their medication.

The second project will launch a digital online health community that connects individuals to others with similar health challenges. The collaboration will aim to develop additional pilot projects to address health conditions such as hypertension, cardiovascular disease, genetic disorders, cancer, and neurodegenerative diseases.

AARP Innovation Labs will provide Howard University researchers with cutting-edge technologies and resources like design thinking training to improve the health of adults 50 and older.

The technology solutions will include mobile apps, sensors, virtual and augmented reality, artificial intelligence, wearables, facial and voice recognition, and data analytics. The team at Howard University will combine the technology with research and care models to assess short- and long-term effectiveness, while facilitating the adoption of disruptive technologies in chronic disease management and underserved communities.

“The partnership combines the strengths of two great organizations, while enhancing tech and innovation initiatives for the most vulnerable,” said Dr. Hugh Mighty, dean of Howard University’s College of Medicine and vice president of clinical affairs.

Researchers noted that in the current pandemic, partnerships and projects like these are especially critical. COVID-19 has disproportionately impacted older adults and underserved populations: A recent analysis from Avalere revealed that in the top 25 US counties with the highest prevalence of COVID-19, the majority of adults aged 65 and older are at high risk for severe illness if they contract the virus.

“The CDC has identified specific populations of individuals who are at higher risk for severe illness from COVID-19, including adults aged 65 and older and people of all ages with certain underlying health conditions,” Avalere researchers stated.

Additionally, a study conducted by researchers at the MIT Sloan School of Management found that COVID-19 death rates in the US are correlated with patients’ age, race, gender, and other social determinants of health data.

The results showed that African Americans and older people are more likely to die from the virus than Caucasians and people under the age of 65.

“Identifying these relationships is key to helping leaders understand both what’s causing the correlation and also how to formulate policies that address it,” said Christopher R. Knittel, the George P. Shultz Professor of Applied Economics at MIT Sloan.

“Why, for instance, are African Americans more likely to die from the virus than other races? Our study controls for patients’ income, weight, diabetic status, and whether or not they’re smokers. So, whatever is causing this correlation, it’s none of those things. We must examine other possibilities, such as systemic racism that impacts African Americans’ quality of insurance, hospitals, and healthcare, or other underlying health conditions that are not in the model.”

With the projects jointly launched by Howard University and AARP, researchers expect to help protect underserved and older populations from severe illness caused by COVID-19.

“Now more than ever, our most vulnerable communities need critical support to stay connected and educated through innovative measures,” said Nigel Smith, Director, AARP Innovation Labs.

“We’re proud to collaborate with Howard University and focus on solutions to help underserved populations better manage their chronic conditions and live healthier lives, throughout the COVID-19 pandemic and beyond.”

The partnering organizations will conduct the pilot projects through Howard University’s 1867 Health Innovations Project, which launched this past April. The project seeks to collaborate with innovators, entrepreneurs, researchers, and corporate partners to address complex health problems facing underserved communities in Washington, DC and beyond.

Through the development and use of digital health solutions, the 1867 will initially focus on virtual healthcare innovations that allow for greater medical care access and health outcomes, specifically in the areas of artificial intelligence, data analytics, voice recognition, and others.

With this new partnership, Howard University and AARP will work to expand and build healthcare solutions for vulnerable patient populations.

“It is important that all communities have access to innovative digital solutions,” said Michael Crawford, Howard University’s associate dean for strategy, outreach, and innovation. “The AARP partnership allows us to test, scale, and accelerate the use of tech solutions for 50+ medically underserved.”