Monthly Archives: January 2017

FDA confirms elevated levels of belladonna in certain homeopathic teething products

The U.S. Food and Drug Administration announced today (Jan. 31,2017) that its laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label. The agency is warning consumers that homeopathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urges consumers not to use these products.
In light of these findings, the FDA contacted Standard Homeopathic Company in Los Angeles, the manufacturer of Hyland’s homeopathic teething products, regarding a recall of its homeopathic teething tablet products labeled as containing belladonna, in order to protect consumers from inconsistent levels of belladonna. At this time, the company has not agreed to conduct a recall. The FDA recommends that consumers stop using these products marketed by Hyland’s immediately and dispose of any in their possession. In November 2016, Raritan Pharmaceuticals (East Brunswick, New Jersey) recalled three belladonna-containing homeopathic products, two of which were marketed by CVS.
“The body’s response to belladonna in children under two years of age is unpredictable and puts them at unnecessary risk,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. ”We recommend that parents and caregivers not give these homeopathic teething tablets to children and seek advice from their health care professional for safe alternatives.”
Homeopathic teething products have not been evaluated or approved by the FDA for safety or effectiveness. The agency is unaware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children. In September 2016, the FDA warned against the use of these products after receiving adverse event reports.
Consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation after using homeopathic teething products.

Northwell Health pivots telehealth services to consumers

by Evan Sweeney | FierceHealthIT
Jan 27, 2017 11:52am

After years of using a telehealth platform to allow clinicians to consult with one another, one of New York’s largest health systems is taking steps to open the service up to patients.
The transition has created new opportunities for units throughout Northwell Health (formerly North Shore-LIJ), according to mHealth Intelligence. A new partnership with a Virginia-based vendor has retooled the systems approach, paving the way for pilot projects across the spectrum of care.
But making the transition to a consumer-facing model requires a comprehensive approach to full-scale integration, said Martin Doerfler, M.D., Northwell Health’s senior vice president of clinical strategy and development and associate chief medical officer.
“Hospitals should stop pretending that direct-to-consumer is telehealth in its entirety,” he said. “Stop doing it just to check that box and move on. It’s a commitment to turning the process inside out [and] becoming patient-centric.”
Hospital executives are shifting their focus toward telemedicine as patients gravitate to digital health tools, despite the fact that reimbursement obstacles still exist.
One of the nation’s largest telehealth initiatives, Project ECHO, has generated tremendous buzz within the healthcare industry, although some say its impact has been overblown.

Trump’s regulatory freeze delays HHS rules

by Evan Sweeney | FierceHealth
Jan 26, 2017 10:33am
An announcement from the White House freezing all new and pending federal regulations has forced the Department of Health and Human Services to withdraw a dozen rules, including one in which the freeze could delay eligibility for those with exchange plans, Medicare Part D or Medicaid.
HHS poverty guidelines, which are updated annually, are used to determine eligibility for government health programs such as Medicaid, Medicare Part D, Children’s Health Insurance Program (CHIP) and ACA tax credits. This year’s guidelines, which were scheduled to take effect on Jan. 19, reflected a 1.3% increase between calendar years 2015 and 2016.
However, the guidelines have been delayed due to a regulatory freeze issued by White House last week. The memo, sent from President Trump’s chief of staff Reince Priebus to the heads of all government agencies, requires any regulations submitted to the Office of the Federal Register (OFR) to be temporarily postponed “in order to ensure the President’s appointees or designees have the opportunity to review any new or pending regulations.”
The memo allows exemptions “for emergency situations or other urgent circumstances relating to health, safety, financial or national security matters.” Regulations that have been published on the federal register but have not yet take effect, will be postponed 60 days from January 20.
Currently, the HHS 2016 poverty guidelines remain in effect. But in a letter to OFR Director Oliver Potts dated January 18, HHS Deputy Director Vanessa Jones made a specific request for the poverty guidelines to be published immediately.
“Multiple programs in [the Centers for Medicare & Medicaid Services] rely on the 2017 guidelines for eligibility determinations at the start of the year,” she wrote. “A delay in the issuance of the guidelines will cause an increased wait period for program-eligible potential recipients of Medicaid, CHIP, Medicare Part D coverage and Marketplace tax credits/cost sharing reductions.”
When asked for comment, HHS directed FierceHealthcare to the agency’s FAQs on poverty guidelines.
Additionally, HHS has withdrawn a notice from the Assistant Secretary for Preparedness and Response (ASPR) issuing declarations under the Public Readiness and Emergency Preparedness (PREP) Act to continue development of a Zika virus vaccine and provide liability immunity to manufacturers. An annual adjustment to civil monetary penalties was also withdrawn.
The regulatory freeze has also delayed several rules born out of the 21st Century Cures Act.
The first, scheduled to publish on Jan. 24, delegated authority to Office of the National Coordinator for Health IT (ONC) to certify health IT developers and oversee the EHR reporting program and the HIT advisory committee.
Another, also scheduled to publish Jan. 24, initiated the process of renewing the contract for the ONC’s Approved Accreditor, which oversees the government’s EHR certification program.
The American National Standards Institute (ANSI) is the ONC’s current Approved Accreditor. It’s a three-year term that expires in June 2017.
A notice from the National Institutes of Health (NIH) was also withdrawn—it would have delegated authority to the agency to establish a task force authorized under 21st Century Cures Act to “refine the clinical trials data registry.”
A spokesperson for the ONC directed questions regarding the rule withdrawals to the White House press office.

Mission Health System uses video game technology to eliminate patient falls

by Evan Sweeney | FierceHealthIT
Jan 23, 2017 10:28am

Using “virtual sitter” technology, a North Carolina health system has eliminated patient falls and injuries among a cohort of neuroscience patients.
During a three-month pilot study, Mission Health in Asheville, North Carolina, used technology commonly used in Microsoft Xbox consoles to create a system in which hospital caregivers could watch patients through a live video feed and create virtual barriers for patients that presented the highest risk of falling, executives with the health system wrote in NEJM Catalyst.
The technology uses depth sensors to detect movement, while infrared cameras create invisible barriers that trigger an alert. This is a step up for hospitals that have used more rudimentary surveillance cameras to prevent falls.
None of the 98 patients selected for the study sustained a fall, compared to a fall rate of 4.06 per 1,000 patient-days among the rest of the patients on the neuroscience unit, coupled with an injury rate of 2.45. Prior to the pilot, the unit had an overall fall rate of 5.74 per 1,000 patient-days, “despite a multicomponent fall-prevention program, compassionate care staff and strong culture of safety,” the authors wrote.
One aspect of the technology’s design proved particularly beneficial. Through a two-way audio system, virtual sitters could intervene verbally to prevent a patient from getting up from a bed or chair, preventing a potential fall and circumventing the need for nurse intervention.
System executives believe they can save more than $250,000 in fall-related costs by expanding the program and further streamlining communications with the care team. According to the CDC, the average cost of a fall injury is $30,000, and in 2015, Medicare paid $31 billion to treat fall injuries.
Patient falls continue to plague providers at “epidemic” levels. In the past, hospitals have used tools developed by the Joint Commission, increased staffing or focused on teamwork-centric approaches. Recently, there has been a growing interest in fall-detection sensors within the consumer market.
Death or serious injuries resulting from a fall is considered a non-reimbursable “never event” by Centers for Medicare and Medicaid Services (CMS). A report released last year found that one in five hospitals don’t have a policy for never events.

In a related story:

5 hospital-proven strategies to prevent patient falls
by Ilene MacDonald | FierceHealth
Oct 6, 2016 12:11pm

Hospitals that have had the most success with reducing patient falls share two common traits: They take the time to measure and analyze specific contributing factors that led to falls and they also have a culture that supports “zero falls,” finds a new report released by the American Hospital Association’s Health Research & Educational Trust.
“Successful organizations developed a culture of pride and ownership about having zero falls, and preventing falls became a mission that resonated on each participating unit or throughout the entire hospital,” said the report (.pdf), “Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project .
The report looks at the results of five organizations that followed Joint Commission recommendations and took a robust approach to fall prevention. The approach incorporates tools from Lean Six Sigma and change management methodologies to reduce falls with injury in inpatient units. Collectively the five hospitals reduced patient falls with injury by 62 percent and patient fall rates by 35 percent.  Based on those results, the report states that a typical 200-bed hospital that followed the approach could expect 72 fewer injuries and avoid $1 million in costs.
The five hospitals that participated in the program are featured in the report and share their best practices to successfully reduce patient falls. Here are a few of their strategies:
A unit-wide educational effort for staff and patients and “Call, Don’t Fall” campaign at an inpatient unit at the Bassett Medical Center, 180-bed, acute care inpatient teaching hospital in Cooperstown, New York, helped lead to a 43 percent reduction of falls.
The campaign focused on human factors–such as patients who are reluctant to ask for help with toileting and staff who wanted to protect the patient’s right to privacy so didn’t proactively assist with toileting–that the organization found commonly led to falls. The organization created signs in patient rooms and common areas reminding patients to call for help before getting out of bed, purchased chair seat alarms that alert staff when patients get off the toilet and has patients at risk for falls wear special gowns, nonskid sockets and lap blankets. Furthermore, the fall prevention team has two daily huddles to identify patients at high-risk of falls and then makes sure nurses help these patients with toileting every two hours. The result is a significant reduction in falls, especially during the night.
Baylor Scott & White Medical Center-Garland, a 113-bed hospital in Texas, developed interventions to improve communication and use of call lights to notify nurses that patients need help with toileting. Part of the problem was that older male patients didn’t feel comfortable asking young female nurses for help with toileting so nurses were advised that if they preferred, they could have a male staff member assist them.
The organization also revised its educational materials and printed them in English, Spanish and Vietnamese with vocabulary at a third-grade reading level. Upon admission, a nurse discusses a patient acknowledgement form with the patient that provides a checklist that encourages patients to use their walkers, canes or braces and handrails in their rooms, bathroom and hallway.
Like Bassett and Baylor, Kaiser Permanente Zion Medical Center in San Diego found that many patients were embarrassed to ask for help or put a higher priority on privacy than on safety. The 414-bed teaching hospital focused its fall prevention efforts in the medical center’s stroke telemetry unit by creating a culture that reinforced a “no one walks alone” approach. Every patient in the unit is considered a fall risk, regardless of age, and as a result bed alarms are set in every room so all patients must be assisted each and every time they leave their bed for any reason.
The fall prevention team conducts hourly rounding when patients are offered bathroom assistance and help repositioning themselves. Unit huddles take place at the beginning of each shift and two hours later to review any changes and observations.
Standardized fall safety messages were developed to help prevent falls with injury among high-risk older patients at Memorial Hermann Memorial City’s cardiology unit. The fall prevention team at the 444-bed hospital in southeast Texas standardized visual cues on the unit, created a post-fall huddle tool and meetings and leader rounding and hourly rounding.
The interventions led to a decrease of fall rates by 50 percent during the study period. The team said it credits the success of the program to three factors: robust process improvement, safety culture and leadership commitment.
A video monitoring system was one of the interventions used by Wake Forest Baptist Medical Center, a 1,004-bed academic medical center in Winston-Salem, North Carolina. Prior to the installation of the equipment, patients identified at high-risk for falls would need a sitter, which was often difficult to schedule. The equipment allowed a video technician to monitor up to eight patients from the nurse’s station at all times. If the technician notices that a patient is trying to get out a bed, he or she places a phone call to a staff nurse and pages all staff on the floor. Patients who were monitored had a 16 percent reduction in falls and a 41 percent reduction in falls with injury.

Hospitals and surgery centers play tug-of-war over America’s ailing knees

by Christina Jewett, Kaiser Health News |
Dec 21, 2016 9:44am
This story originally appeared in Kaiser Health News.
Five years ago, Ira Kirschenbaum, M.D., an orthopedic surgeon in the Bronx who replaces more than 200 knees each year, would have considered it crazy to send a patient home the same day as a knee replacement operation.
And yet there he was this year, as the patient, home after a few hours. A physician friend pierced his skin at 8 a.m. at a Seattle-area surgery center. By lunch, Kirschenbaum was resting at his friend’s home, with no pain and a new knee.
“I’m amazed at how well I’m doing,” Kirschenbaum, 59, said recently in a phone interview, nine weeks after the operation.
What felt to Kirschenbaum like a bold experiment may soon become far more standard. Medicare, which spends several billions of dollars a year on knee replacements for its beneficiaries—generally Americans 65 and over—is contemplating whether it will help pay for knee replacement surgeries outside the hospital, either in free-standing surgery centers or outpatient facilities.
The issue is sowing deep discord in the medical world, and the debate is as much about money as medicine. Some physicians are concerned that moving the surgeries out of hospitals will land vulnerable patients in the emergency room with uncontrolled pain, blood clots or other complications.
But proponents of the change say it can give patients more choice and potentially better care, as well as save Medicare hundreds of millions of dollars. Already, an “overwhelming majority” of commenters said they want to allow the surgeries out of hospitals, according to recent rule-making documents.
The final decision, which could come within a year, would also act as a test of sorts for Donald Trump and his new administration. They will weigh whether to limit government controls, as Trump has often suggested, or to bend to pressure from hospitals and doctors, many of whom oppose the change.
“I think the question will come down to two things,” said David Muhlestein, senior director for research at Leavitt Partners, a leading health consulting firm. “It’s the balance of trying to reduce regulations and let the market function—and the competing interest of vested parties.”
Demand for total knee replacements is growing—660,000 are performed each year in the United States. That number is likely to jump to two million annually by 2030, making this complex and expensive operation one of surgery’s biggest potential growth markets.
Even if the policy change is made, Medicare would still pay for patients to get traditional inpatient surgery. But with the agency also paying for the bulk of outpatient procedures, there would be a huge shift in money—out of hospitals and into surgery centers. Medicare could save hundreds of millions of dollars if it no longer needed to pay for multiple-day stays at the hospital. Investors at the outpatient centers could profit greatly, as could some surgeons, because doctors often have an ownership stake in the outpatient centers where they operate.
Whether the shift is beneficial for patients remains an open question. Medicare patients tend to spend nearly three days in a hospital, data shows. Forty percent of Medicare patients also spend time in a rehabilitation facility for further recovery. The data, which reflects knee replacement operations from 2014, suggests that Medicare patients are taking advantage of the post-operation support at hospitals and aftercare centers. Given that, it is unclear the percentage of eligible patients who would choose outpatient care.
But improvements in surgery—from new medicines to control bleeding to better pain management techniques—mean that, for some patients, the days of close medical supervision are no longer necessary.
Kirschenbaum, who is in favor of the change, acknowledged that outpatient surgery would be the right move for only a small subset of his Medicare patients—perhaps 10 to 15 percent—who have good caretaking at home and few chronic health issues. But it would not be for the people who are frail, live alone or in a dwelling with stairs, he said. The decision about whether an outpatient surgery should be done instead of an inpatient one tends to be made by the physician and patient.
“We want to make sure patients—when they go home, they’re safe, no question,” said Kirschenbaum, the chairman of orthopedics at Bronx-Lebanon Hospital Center and a founder of SwiftPath, a company that offers technical support to outpatient joint replacement centers.
Perhaps of equal concern to patients are the financial consequences, because even though less care is given, outpatient procedures require higher out-of-pocket costs for patients. Medicare covers inpatient procedures 100%, with no patient copayment. Outpatient procedures, though, require patients to contribute a 20% copayment, which would easily add up to thousands of dollars in the case of knee surgery.
The battle lines over outpatient knee replacements began forming in 2012, when Medicare first considered removing the surgeries from its “inpatient only” list of invasive and complicated medical procedures. Many orthopedic doctors and hospitals rose up in protest, calling the proposal “ludicrous” and “dangerous” and prompting Medicare to abandon the idea.
Charles Moon, M.D., who has performed knee replacement surgeries at Cedars-Sinai Medical Center in Los Angeles, fired off a letter at the time saying that knee replacement patients stayed at his hospital for 2.5 days on average, and that that was “considered borderline safe” given the need to monitor patients’ response to clot-busting medications.
Other objectors cited research showing that patients who received knee replacements as outpatients were twice as likely to die shortly afterward, and that even one-day-stay hospital patients were twice as likely to need a follow-up surgery, compared with those who remained inpatients longer.
“While we realize this can be good for some patients, it’s not for all patients and all locations,” said Thomas C. Barber, M.D., the chairman for the American Academy of Orthopaedic Surgeons’ advocacy council.
Yet the proposal has gained renewed momentum, backed aggressively by some surgeons and surgery center investors who say that their accumulating experience justifies the change. In recent months, Medicare has signaled a strong interest in outpatient knee replacements, noting the potential for “overall improved outcomes” as well as the potential savings for the government program.
The final decision is made by Medicare officials in the annual course of proposing changes, seeking public input and announcing a final rule. If Medicare does decide to make a change, it would probably not be put into effect until a year or so later.
In an interview, Thomas Wilson, the chief executive of the for-profit Monterey Peninsula Surgery Centers, an outpatient clinic, said his doctors have replaced knees of hundreds of adults—59 years old on average, but up to 82—with low complication rates and sky-high satisfaction rates. He said advances in surgical technique, anesthetics and patient education make it possible.
Presented with such evidence, a panel that recommends hospital outpatient payment policies to Medicare officials unanimously recommended in August that Medicare remove the procedure from the “inpatient only” payment list.
Wilson said that as a first step, doctors should use strict criteria for choosing which patients are good candidates, like a low to moderate body mass index and a healthy heart and lungs.
Patients who meet the criteria are teamed with a friend or family member who works as a coach. The patient and coach attend an educational session before the operation, and the coach is also there to help after.
The patient is typically discharged after 23 hours in the outpatient center, and a home health service or private nurse follows up. Patients also go on to physical therapy.
“Our mix is like our regular mix of patients,” said Wilson, whose center advertises a knee replacement surgery for $17,030. “It’s not what we call unicorns, not 49-year-old marathon runners. These are average folks who need to have a knee or hip replaced and they’re generally not sick.”
But Barber and others worry that moving the procedure outside the hospital could become a norm or an expectation, even though some patients, especially those with complicating conditions like diabetes and heart disease, need the added support of a hospital team. Patient safety could be compromised, they warned.
Kirschenbaum said undergoing surgery has changed the way he approaches patients. Now he can roll up his pant leg, show a scar and tell them: “You can do this, too.”
In the operating room, “with a knife in my hand, nothing has changed,” he said. “But what has changed is how we treat them before and after. The education, support and being available—it’s very important.”

VA makes big strides in efforts to reduce hospital-acquired MRSA infections

by Paige Minemyer |
Jan 5, 2017 4:06pm

The Department of Veterans Affairs has made significant progress with its efforts to reduce methicillin-resistant Staphylococcus aureus (MRSA) at its facilities.
The research, published in the American Journal of Infection Control, found that over an eight-year period, MRSA hospital-acquired infection rates dropped by 87% in intensive care units and 80% in wards outside the ICU. Significant reductions were also recorded at the VA’s long-term care facilities, according the study, as HAI rates dropped by nearly 50% between July 2009 and September 2015.
VA hospitals established the reduction initiative in 2007 as MRSA infection rates were “unacceptably high,” according to the study announcement. A 2013 study found that the program had already led to significant reductions in MRSA infection rates between 2007 and 2012. A dedicated MRSA prevention coordinator was added to each facility, according to the announcement, and the program emphasized hand-hygiene, better screening during transfers or discharges and a culture change that put a spotlight on infection control.
“Understanding how and why rates of MRSA have diminished in recent years is essential for the continued progress of effective prevention programs,” lead study author Martin E. Evans, M.D., a doctor at Lexington VA Medical Center, said in the announcement. “As we seek to protect patients from MRSA and other resistant organisms, our study supports the need for strong infection prevention programs at every healthcare facility.”
The federal government will begin penalizing hospitals this year for high MRSA infection rates. Many of the biggest names in the industry have trouble controlling hospital-acquired infections, like MRSA and Clostridium difficile, which can be deadly for patients. Better hand-hygiene compliance and antibiotic stewardship programs are key solutions promoted by infection control experts.

OIG: Inpatient stays down under two-midnight rule but vulnerabilities remain

by Ilene MacDonald | FierceHealthcare
Dec 19, 2016 11:08am
Although inpatient stays have decreased since Medicare established the two-midnight rule, a new Office of Inspector General report finds several weaknesses remain in the policy.
The report (PDF) states that the Centers for Medicare & Medicaid Services must improve oversight of hospital billing under the policy and increase protections for beneficiaries.
The policy allows Medicare to pay for inpatient claims if the physician expects that the Medicare patient’s care will last at least two midnights. Shorter stays are billed as outpatient services. The controversial policy was implemented in 2014 to reduce improper payments for short inpatient stays, inconsistent use of inpatient and outpatient stays among hospitals, and the number of Medicare beneficiaries who had long outpatient stays and thus didn’t quality for skilled nursing facility services.
The OIG report analyzed Medicare hospital claims for inpatient and outpatient stays in fiscal years 2013 and 2014 to determine differences in types of stays before and after the government implemented the policy in 2014.
The good news is that the number of inpatient stays has decreased and the number of outpatient stays increased since the implementation of the policy. In addition, short inpatient stays decreased more than long outpatient stays. However, the OIG found five vulnerabilities still exist:
• Hospitals may be inappropriately billing for short inpatient stays under the policy. Forty percent of all short inpatient stays were potentially inappropriate, the report found, noting that Medicare paid nearly $2.9 billion for these claims in fiscal year 2014.
• Medicare pays more for some short inpatient stays than for short outpatient stays even though the hospitalizations are for similar reasons.
• Hospitals continue to bill for a larger number of long outpatient stays.
• Medicare patients pay more for outpatient stays and have limited access to skilled nursing facility services than they would as inpatients.
• Hospitals still vary in how they use inpatient and outpatient stays.
To address these issues, the OIG suggests that the CMS take a tougher stance on enforcement of the policy. Indeed, enforcement has been limited since the policy was implemented, according to the report. Hospitals may also have financial incentives to use short inpatient stays, and in fact, some hospitals have increased their use of these stays since the policy took effect, the OIG said.
The OIG recommends that the CMS conduct routine analysis of hospital billing, targeting for review hospitals that have high numbers of short inpatient stays that might be inappropriate. “Such oversight is even more important given the change made in 2016 to allow for case-by-case exceptions to the two-midnight policy. This policy change has the potential for abuse and should be monitored closely,” the report said.
In addition, the OIG suggests that the CMS:
• Analyze the potential impact of counting time spent as an outpatient toward the three-night requirement for skilled nursing facility services so that Medicare patients can have access to the services.
• Look for ways to prevent Medicare patients from paying more for outpatient stays than they would as inpatients.
The CMS agreed to all the recommendations, according to the report.

Unnecessary surgeries: 4 ways to reduce C-sections

by Paige Minemyer | FierceHealthcare
Dec 19, 2016 10:34am

More than 60% of reporting hospitals had excessive rates of cesarean section, according to the Leapfrog Group, but there are steps that they can take to reduce them.
Leah Binder, CEO of Leapfrog, writes in a column for Forbes that hospitals should adopt four strategies to reduce the number of unneeded C-sections and wasteful surgeries overall. She notes that in the past 20 years the number of Cesarean sections performed has increased by more than 50%.
Indeed, a 2014 Consumer Reports analysis found that hospitals perform C-sections for a variety of reasons, including ease of scheduling and patient or doctor convenience. But many of the surgeries are unnecessary and can lead to additional risks for patients and higher costs.
“Pressure to change has to come from inside the healthcare system and from outside, from the market,” Binder writes.
To reduce unnecessary surgeries, she suggests that hospitals:
1. Be transparent and participate in public data reporting to help make the problem clearer to both providers and patients.
2. Support payment reforms. Some providers will not pay more for C-section births, Binder writes, and in South Carolina, Medicaid has announced it will pay one rate for all births.
3. Involve clinicians. As patients become more aware of the high rates of C-sections, they’ll likely ask obstetricians about other approaches. Doctors must be ready for those conversations, Binder says, and should lead movements to reduce those rates.
4. Seek support from system leaders. Hospital leaders must be behind a change in the organization’s culture, encouraging staff education about different ways to support women in labor.

Joint Commission reaffirms ban on texting orders

by Paige Minemyer | FierceHealthcare
Jan 9, 2017 11:02am
Citing burdens on clinicians that could lead to treatment delays, the Joint Commission said its ban on doctors using text messages to order treatments will stay in place for the time being.
The Joint Commission briefly lifted the ban last spring, but then temporarily reinstated it over the summer to allow the Commission more time to work with the Centers for Medicare & Medicaid Services. The groups are working out guidelines for how doctors can use messaging apps and texting to make orders. However, through those conversations, the agencies agreed that until several concerning issues were fixed as texting technology continues to evolve, it is best for the ban to remain in place for now, according to the announcement (PDF).
The agencies identified a number of concerns that led to the decision:
• Using texts or other messaging apps to order treatments could increase the burden on nurses or other clinical staff who would be responsible for inputting such data into electronic health records
• Talking in-person allows for easier clarifications if there are questions about an order, and allows for better confirmation of directives
• If there are any clinical decision support alerts triggered during the EHR process, the clinician inputting the information into the system will have to take time to contact the ordering physician to resolve the issue, potentially causing treatment delays
The commission and CMS will continue to monitor advancements in texting to further evaluate the ban and other guidelines in the future, according to the announcement. New advancements in texting technology led to the ban being lifted last year, FierceHealthcare previously reported.
Research has found that secure text messaging may be an effective method of communication, perhaps even better than traditional paging. One such study, published last April in the Journal of General Internal Medicine, found that a hospital that switched to a secure texting system saw a decrease in the average length of stay, though readmission rates were not impacted.

mHealth roundup: Health apps to cut costs, improve care

by Judy Mottl | FierceHealthcare
Jan 12, 2017 9:05am

Mobile apps are ubiquitous in wellness and healthcare, driven by consumers eager for healthcare information at their fingertips. Hospitals, health systems and health insurance companies have embraced them as a way to provide better, faster and more cost-effective care and treatment.
A top focal point for app makers has been management of chronic illness, such as diabetes, as the population of patients diagnosed with Type 2 diabetes swells. Health and fitness are also a prime focus for payers and providers and are popular with consumers.
But app makers are working to expand beyond those entry-level functions to tackle everything from patient care and management to back-end operations and streamlined business processes.
Here’s a roundup of some of the promising mHealth app developments FierceHealthcare reported on in 2016:
NewYork-Presbyterian launched a digital health suite to enhance patient care and foster faster and easier interaction among physicians. It includes an app called Digital Second Opinion that lets patients contact specialists from ColumbiaDoctors and Weill Cornell Medicine via an online portal. Another app in the suite provides wider access to specialty care across the New York City region and a third app provides virtual consult follow-up in lieu of an in-office visit.
NYP and Regional Hospital Network began working on an app to improve communication and access to care providers, with features ranging from mobile payment to data access.
Mount Sinai Health System debuted an Android version of its mobile application for patients, called MountSinaiNY, which provides a one-touch patient experience, featuring information and links to access health services. The app initially debuted in the Apple App Store in June 2016. The organization has plans to update the app to include telemedicine, wayfinding and enhanced access to Mount Sinai services.
The Icahn School of Medicine at Mount Sinai launched an enterprisewide platform that lets doctors prescribe apps to patients and offers an “app store” of evidence-based apps integrated with the systems’ digital prescription delivery system. The RxUniverse platform helps patients easily find effective health apps that will allow them more control of their health.
Centura Health in Colorado debuted an app to cut emergency room visits and hospital readmission rates. The app is aimed at providing house call and care coordination by allowing patients to communicate with providers in medical situations that may or may not require an ER visit.
McGill University Health Centre researchers created an app that enabled collaborative, real-time patient data entry and streamlined, smoother patient handoff. The Canada organization’s FLOW app lets care teams share and enter short notes as well as use tags to set priorities.
Apps to monitor, treat diabetes
More than 1,500 apps assist with diabetes treatment and management, with a good number aiming to improve daily blood testing and sugar level monitoring. As a Cardiff University School of Medicine study revealed this year, Type 2 diabetics can benefit from smartphone apps that offer disease self-management features.
The American Diabetes Association used IBM’s Watson technology for an app aimed at identifying patterns in lifestyle and health to drive better treatment and disease management. The two also partnered to create a personalized mHealth app that gets smarter over time and works with Watson Care Manager. They are also teaming on a diabetes-focused app development challenge.
Scripps Health researchers are studying the value of text messaging value in a clinical trial focused on improving diabetes management among a high-risk Hispanic patient population in San Diego County.
A study published in the Journal of Medical Internet Research revealed apps and messaging might help teens control their Type 1 diabetes.
Apps to aid in mental health
Tools for assessing, diagnosing and treatment mental health issues have been stymied due to potential harm or risk the tools caregivers believe could come into play. But as one psychiatry resident wrote in a blog post, even emerging apps that don’t hit the “gold standard” may prove viable.
The viewpoint may be grabbing more traction as telemedicine companies grow their mental health services.
A recent study published in the Journal of Medical Internet Research revealed apps offering educational intervention, along with the ability to monitor and support positive behavior change, could lessen the risk of Alzheimer’s disease.
Duke University launched a research app that aims to determine autism risk and help patients detect that condition and mental health issues early.
And biopharmaceutical company Pfizer is offering a free app to help patients manage depression and share their progress with physicians.
Apps for cardiac interventions
Boston Medical Center researchers began redesigning a popular diet plan, the Dietary Approaches to Stopping Hypertension regimen, into a app offering to help patients better control and manage hypertension.
Apps for dental care, diagnostics, women’s health and asthma
A University of Pittsburgh dental student conceived the DentaCom app, which promises to spur faster dental care and reduce unnecessary emergency room visits. The tools let users snap a photo, provide data and share with a dentist for assessment before heading to the ER.
The University of Washington developed an app to analyze and measure hemoglobin faster, easier and cheaper. Called HemaApp, it has proven to be as reliable as the more expensive finger sensor approach.
UNICEF partnered with Johnson & Johnson to create MomConnect and several additional digital tools that aim to provide better maternal health to mothers-to-be in South Africa and will serve as the foundation for an expanded software tool to boost literacy, as well. MomConnect is focused on boosting health and wellbeing as well as empowering women in South Africa and is the first integrated maternal health platform on the continent. Another app is helping humanitarian aid teams working in Syria and providing access to research and assistance.
Children’s Health in Texas said the My Asthma Pal app cut ED readmissions in half. The app allows for data sharing between patients and providers—the next step is to integrate the data it collects into the electronic medical record.
Even as mHealth apps have come into their own, there are still challenges. Measuring effectiveness and return on investment and getting patients not only to use mHealth platforms but to continue using them can be tricky.
Then there’s the overwhelming number of healthcare app choices. Nearly 100,000 new apps have been launched since the beginning of 2015, with 13,000 new publishers moving into the market over that same period. About 259,000 apps currently are available in the top app stores, according to a Research2Guidance report (PDF).
The mHealth app movement is being encouraged by the American Medical Association, which released new guidance last November about clinical mHealth apps that support patient-centered care delivery, care coordination and team-based communication. It’s aimed at fostering integration of digital health innovations into clinical practice.
The regulatory landscape has also shifted. In July, the Food and Drug Administration said mobile apps won’t fall under tough FDA review as long as they promote general wellness and present a low risk to users.