Can i get ventolin over the counter uk

Using a zebrafish model, researchers from North Carolina State University have found that vitamin D deficiency during early development can disrupt the metabolic balance between growth and fat can i get ventolin over the counter uk accumulation. The results suggest a linkage between vitamin D and metabolic homeostasis, or equilibrium. The research team, led by Seth Kullman, professor of biological sciences at NC State, looked at groups of post-juvenile zebrafish on one of three diets.

No vitamin D (or vitamin can i get ventolin over the counter uk D null), vitamin D enriched and control. The zebrafish spent four months on their particular diet, then the researchers looked at their growth, bone density, triglyceride, lipid, cholesterol and vitamin D levels. They also examined key metabolic pathways associated with fat production, storage and mobilization and growth promotion.

The zebrafish can i get ventolin over the counter uk in the vitamin D deficient group were, on average, 50% smaller than those in the other two groups, and they had significantly more fat reserves. €œThe vitamin D deficient zebrafish exhibited both hypertrophy and hyperplasia – an increase in both the size and number of fat cells,” Kullman says. €œThey also had higher triglycerides and cholesterol, which are hallmarks of metabolic imbalance that can lead to cardio-metabolic disease.

This, combined with the stunted growth, indicates that vitamin D plays an important role in the ability to channel energy into growth versus into fat storage.” can i get ventolin over the counter uk After the initial testing, the vitamin D deficient zebrafish were given a vitamin D enriched diet for an additional six months, to see if the results could be reversed. While the fish did continue to grow and begin to utilize fat reserves, they never caught up in size with the other cohorts and they retained residual fat deposits. €œThis work shows that vitamin D deficiency can influence metabolic health by disrupting the normal balance between growth and fat accumulation,” Kullman says.

€œSomehow the energy that should be can i get ventolin over the counter uk going toward growth is getting shunted into creating fat and lipids, and this occurrence cannot be easily reversed. While we don’t yet understand the mechanism, we are beginning to tease that out.” Future work will involve looking at the offspring of vitamin D deficient mothers, to determine whether this vitamin deficiency has epigenetic effects that can be passed down. The research appears in Scientific Reports and is supported by the Environmental Protection Agency (STAR RD-83342002) and the National Institute of Environmental Health Sciences (grants T32 ES07046, P30ES025128, R35ES030443 and P42ES004699).

Kullman is can i get ventolin over the counter uk corresponding author. Megan Knuth, former NC State Ph.D. Student currently at the University of North Carolina Chapel Hill, is first author.

Debin Wan and Bruce Hammock, both from the University of California Davis, also contributed to the work. -peake- Note can i get ventolin over the counter uk to editors. An abstract follows.

€œVitamin D deficiency serves as a precursor to stunted growth and central adiposity in zebrafish” DOI. 10.1038/s41598-020-72622-2 Authors can i get ventolin over the counter uk. Megan M.

Knuth, Debabrata Mahapatra, Dereje Jima, Mac Law, Seth W. Kullman, North can i get ventolin over the counter uk Carolina State University. Debin Wan, Bruce Hammock, University of California DavisPublished.

Online Sept. 29, 2020 in Scientific Reports Abstract:Emerging evidence demonstrates the importance of sufficient vitamin D (1α, 25-dihydroxyvitamin D3) levels during early life stage development with deficiencies associated with long-term effects can i get ventolin over the counter uk into adulthood. While vitamin D has traditionally been associated with mineral ion homeostasis, accumulating evidence suggests non-calcemic roles for vitamin D including metabolic homeostasis.

In this study, we examined the hypothesis that vitamin D deficiency (VDD) during early life stage development precedes metabolic disruption. Three dietary cohorts of zebrafish were can i get ventolin over the counter uk placed on engineered diets including a standard laboratory control diet, a vitamin D null diet, and a vitamin D enriched diet. Zebrafish grown on a vitamin D null diet between 2-12 months post fertilization (mpf) exhibited diminished somatic growth and enhanced central adiposity associated with accumulation and enlargement of visceral and subcutaneous adipose depots indicative of both adipocyte hypertrophy and hyperplasia.

VDD zebrafish exhibited elevated hepatic triglycerides, attenuated plasma free fatty acids and attenuated lipoprotein lipase activity consistent with hallmarks of dyslipidemia. VDD induced dysregulation of gene networks associated with growth hormone and insulin signaling, including induction of suppressor of cytokine signaling.

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Reps. Jason Smith, R-Mo., and Josh Gottheimer, D-N.J., introduced legislation this week to ensure Medicare enrollees have expanded access to telehealth.HR 3447, or the "Permanency for Audio-Only Telehealth Act," would allow for Medicare coverage of audio-only telehealth services after the asthma treatment public health emergency. "The asthma treatment ventolin required the U.S.

Healthcare system to innovate and embrace every viable method of healthcare delivery. For patients in rural areas back home in Missouri, none have been more beneficial than the expansion of audio-only telehealth," said Smith in a statement. "This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight," he continued.

WHY IT MATTERS As the legislators noted in a press release, the Centers for Medicare and Medicaid Services allowed healthcare providers to offer audio-only telehealth under Medicare and Medicaid plans during the public health emergency. This has allowed rural patients and low-income people, as well as seniors and those with physical limitations, to continue accessing necessary care. However, those flexibilities will expire at the end of the public health emergency, noted legislators, presenting a clear need for long-term policy.

In addition to covering audio-only telehealth, HR 3447 would remove geographic and originating site restrictions for Medicare beneficiaries to access audio-only telemedicine. "The ventolin has created challenges for everyone, but it's also shown us that technology can provide safe and dependable communication between patients and their doctors," said Gottheimer in a statement. "Innovations including telehealth and audio-only capabilities will improve efficiency, reduce costs, and increase access to health care providers – especially for our seniors and our rural communities," he added.

THE LARGER TREND Health equity advocates have repeatedly pointed to the need for audio-only telehealth coverage, given the lack of access to affordable and reliable broadband throughout much of the country. President Joe Biden's administration has taken some steps to address that connectivity need. But in the meantime, other legislators have introduced similar bills that would focus on covering virtual care without a video component.

Earlier this year, members of Congress put forth legislation that would allow providers to offer audio-only services to Medicare Advantage patients, garnering praise from America's Health Insurance Plans. "The bipartisan legislation is another example of how the public and private sector can work together to improve healthcare affordability and access for all Americans," AHIP wrote in a statement. ON THE RECORD "During the asthma treatment ventolin, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits," said Andres M.

Gilberg, senior vice president of government affairs for the Medical Group Management Association. "The need for these services will not disappear upon the conclusion of the asthma treatment public health emergency, but the ability to deliver them to Medicare beneficiaries will without congressional action," Gilberg said."Patients should not be penalized for living far away from healthcare facilities or living in areas with inadequate Internet access," he added. Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Community Health Network, based in Indianapolis, Indiana, faced three engagement problems – a lack of automation, a lack of personal or disease-specific communications and tremendous variation due to point solutions.THE PROBLEMCommunicating with patients was completely driven by live telephone interactions. It was clear the health system needed a more automated solution for appointment reminders and other messaging, for important touchpoints, like when a patient leaves the hospital or emergency department, said Dr.

Patrick McGill, executive vice president and chief analytics officer at Community Health Network."In addition, asthma treatment created another barrier to patient communication, as the office staff was saturated with other duties," he said. "In the few automated solutions that Community Health Network did deploy, there remained a significant amount of manual touching for the communications."Nursing leaders are encouraged, on patients in their unit, to understand how their care and experience is going, if the patient has any acute needs, and how the staff are performing," he continued. "Throughout Community Health Network there was tremendous variation in the nurse leader rounding process.

Every nursing leader seemed to do it differently, asking different questions, which left us with no way of tracking compliance and determining which leaders were actively rounding on their patients."PROPOSALCommunity Health Network was interested in a comprehensive, enterprise vendor to help solve all of these problems – lack of automation, lack of personalization and variation in practices.In addition to programs that had a solution in place, Community Health Network wanted to expand its digital solutions consistently across the entire network. Transitioning to a single vendor with a single platform created efficiencies in execution and cost savings, and allowed for enterprise standardization versus each department or area having their own solution, McGill said."We are on track to prevent 2,992 inpatient days due to readmission."Dr. Patrick McGill, Community Health NetworkMost important, it allowed for a consistent patient experience, he added.The health system decided to turn to health IT vendor CipherHealth.MEETING THE CHALLENGE"CipherHealth technology was deployed in several areas – nurse leader rounding, patient appointment reminders, asthma treatment screening pre-appointment calls and post-discharge call-backs," McGill said.

"In nurse leader rounding, we initially deployed a standard digital tool at one hospital for nursing leaders to round on patients in the unit and ask uniform questions with documented responses allowing for consistent follow-up, measurement of areas of opportunity, and increased patient satisfaction and engagement due to consistent leader interactions."It allowed more real-time "voice of the customer" to be captured, he added."In patient appointment reminders, patients are texted or receive an automated call based on their preferences five days and two days prior to their appointment," McGill explained. "This allows them to conveniently confirm or cancel, and allows us to reduce no-shows. Having an automated system allows for reduced staff time on calling patients since this was an entirely manual process prior to the implementation of CipherHealth."The asthma treatment ventolin has introduced another need, which is to screen patients for asthma treatment symptoms prior to their arrival for an appointment.

Prior to CipherHealth's tool, this was entirely manual and took several hours per day of office staff to screen and confirm patients prior to their appointment. It also generated an increased call volume since many patients were not reached on the first attempt.Then came post-discharge callbacks."After a patient leaves the hospital or ED, they'll receive a call to evaluate their status, determine if they have any acute needs following the hospitalization or ED visit, and ask if they received all of the follow-up services ordered during their care," McGill said."Prior to CipherHealth, these calls were manually completed by a nurse, using up significant time and resources. Additionally, we had different teams of nurses calling the patients and had varying but overlapping questions."The population health team, for example, had one set of questions, while the patient experience team had a completely different set."Finally, the questions were often generic and might not apply to a specific patient's circumstances," he added.

"With the new solution, all these problems were solved – one team with disease-specific and standard questions managed automated calling and only needed to call the patient manually when a specific need was identified. This allowed faster person-to-person connections, as well as faster and easier issue resolution."RESULTSThe results achieved so far have been powerful across several KPIs."We saw a 1.2% reduction in no-show rates after implementing CipherOutreach," McGill reported. "Across five hospitals, that nets out to an additional almost 40,000 appointments.

We sent out 1.55 million patient reminders, with 1.2 million successfully reaching their recipients. Our pediatrics specialty showed the highest engagement, with a 92% reach rate. Across all specialties, we received a response rate of 41%, with 94% of respondents confirming their appointments."Then there was the impact on annual revenue."With average net revenue per visit at $78, our reduced no-show rate equaled real dollars," he noted.

"With just shy of 40,000 appointments that otherwise would have been no-shows, we added an estimated $3.1 million to our annual revenue, just from reducing appointment no-shows."Further, the health system achieved lowered readmissions."Our patients who received post-discharge outreach were 32% less likely to be readmitted following their initial hospitalization or ER discharge," McGill said. "Between July 1, 2020, and December 31, 2020, we had 1,240 actual 30-day readmission inpatient days. Without leveraging post-discharge outreach, we estimate those inpatient days would have jumped to 3,220, meaning that on an annual basis, we are on track to prevent 2,992 inpatient days due to readmission."The health system also made progress on staff recognition and satisfaction.

After battling the ventolin for a year, staff members are exhausted, so the health system has been trying to find every opportunity it can to honor their hard work. CipherHealth's Caregrams functionality allows patients to nominate staff members deserving of recognition. So far, 1,000 staff members have been honored through Caregrams.ADVICE FOR OTHERS"First, find a partner that is – and will act like – a partner," McGill advised.

"There are many companies out there in this digital space selling solutions but not partnerships. Second, work with a partner that offers enterprise-wide solutions – inpatient, outpatient, ED, etc. Third, there is a balance between automation and customization.

You need to find a partner that can do both."Any great partner will be willing to truly dive into the organizational struggles and develop solutions if they do not currently have an offering, although in our experience, many companies will say they do this in order to make a sale," he concluded. "Do your homework and investigate."Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.[Note. This piece has been updated to include comments from Zocdoc.]The medical scheduling site Zocdoc published a letter this week describing a programming error that allowed patient information to be exposed to providers in an unauthorized manner. As Zocdoc explained, the bugs allowed practice staff members to access the vendor's system after their login information was intended to be limited.

"Based on our investigation, we do not believe that any misuse or unauthorized access to unsecured personal information has occurred, or that any Zocdoc systems were compromised," said Zocdoc representatives in an email to Healthcare IT News after publication."Out of an abundance of caution, and out of respect for and our continued commitment to compliance with all regulatory requirements, we are notifying affected individuals and practices of this issue," they added.WHY IT MATTERS As Zocdoc explained in its letter, each practice registered with Zocdoc receives usernames that allow staff members to access its Provider Portal. There, providers can view appointments and other information furnished by patients when booking. "Beginning in August 2020, we learned of programming errors that allowed some past or current practice staff members to access the Provider Portal after their usernames and passwords were intended to be removed, deleted or otherwise limited," read the letter.

The company noted that the practices have their own obligations to maintain patient security and confidentiality. Any personal information would include name, email address, phone number and appointment history, as well as insurance member ID, social security number and any relevant medical history provided to the practice via Zocdoc. The information would not have included credit card numbers, debit card or PINs, bank account information, radiological or diagnostic reports or any medical records.

"These were not vulnerabilities exploitable by any third parties. Rather, this incident is specific to the access rights of our provider client accounts," said Zocdoc representatives.Zocdoc noted that it launched an internal investigation to repair the errors and that it is offering a year of identity theft protection through Experian IdentityWorks for affected patients. According to TechCrunch's Zach Whittaker, about 7,600 users across the United States were affected.

Whittaker also notes that Zocdoc reported a similar incident in 2016. "We repaired these errors, and the affected usernames can no longer access our system," said the vendor.THE LARGER TREND Although the highest-profile patient-information breaches of late have involved ransomware, human error has also led to some major missteps.Early this month, for example, an employee of the Wyoming health department accidentally uploaded the asthma treatment, influenza and blood alcohol test results for more than a quarter of the state's population to a public-facing website. Three years ago, a Blue Cross employee uploaded a file containing member information to a website where it remained visible to the public for three months.

ON THE RECORD "We have … strengthened our security practices and are taking appropriate steps to prevent an incident like this from recurring," said Zocdoc in the letter. "We will continue to regularly audit our system security and take action to enhance it." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.New York City was hit hard and fast by asthma treatment in early 2020. At NYU Langone Health, the crisis was met with a swift, multi-pronged, analytics response. Clinical informaticists and analytics teams worked closely with hospital operations and institutional leadership to build a source-of-truth asthma treatment dataset for the institution, to identify and define key metrics, and build near-real-time dashboards.Additionally, the teams constructed a de-identified asthma treatment data repository to support the many research projects related to asthma treatment and enhance education around informatics and data use.Communicating data and analytics needs"NYU Langone Health has existing processes in place that allow for operational leadership to communicate data and analytics needs to our medical center IT department," said Dr.

Eduardo Iturrate, health IT safety officer and medical director for enterprise data and analytics at NYU Langone Medical Center."These processes include several committees that allow leadership to identify and describe needs to MCIT, as well as a reporting and metrics committee, which serves as the venue for governance and to rigorously define metrics to a degree that can be operationalized by reporting analysts to be built and then flow to the health system's existing dashboard infrastructure," he added.The dashboard infrastructure is another essential piece of the puzzle that allows for rapid development of consumable business intelligence for health system leadership, he said."The dashboard system is a flexible, extensible system that has permission schemes built in to allow for the creation of publicly accessible dashboards as well as dashboards with a limited distribution list as defined by operations," he said."Finally, our underlying enterprise data warehouse is the backbone data infrastructure that underpins our systems ability to use data and analytics to inform leadership."Several institutional challengesThe development of the de-identified asthma treatment data repository required surmounting several institutional challenges, some of them technical and others related to getting bureaucratic approval to move forward."In order to proceed, we needed to present the idea of developing the dataset, and in particular we needed to define the scope of use that we were proposing," Iturrate explained. "This was reviewed by our architecture governance committees, as well as by our legal and compliance departments."We developed a data use agreement for this effort that formalized the scope of use and, in collaboration with these groups, determined that we would restrict sharing of the dataset to only members of the NYU Langone Health community."This limitation guided our technical approach to de-identification and allowed us to define a degree of de-identification along the spectrum toward anonymization that satisfied institutional concerns related to exposing patient health information," he added."We also then needed to build tools and infrastructure to allow users to have secure access to the dataset, and to that end we created an approach to use a virtual desktop with pre-installed data analysis tools."Finally, staff need to build out the support and systems to accommodate requests for the addition of data elements to the system and for the development and sharing of derived data elements, he said.A big impactIn the end, these dashboards and de-identified data repositories could have quite an impact."Having operational dashboards with timely and accurate data about the patient care conditions that affect the organization allows operational leadership to make informed decisions regarding resource allocation and strategic planning," Iturrate said."This was crucial during the rapidly changing landscape of the evolving asthma treatment crisis, which forced our health system (and others) to reinvent itself rapidly to respond to the crisis."The de-identified data repository expands access to clinical data to the research community by providing a degree of self-service access to clinical data," he continued. "This approach improves the bottleneck that can exist related to requests for clinical data that are limited by the number of available data analysts."Additionally, the de-identified data repository allowed staff to encourage collaboration and make connections between researchers and data scientists across all campuses and many academic departments of the large health system.

The data repository allowed for the generation of several research manuscripts that may have been held up by usual research request processes.Iturrate will offer more detail during his HIMSS21 session, "Case Study. Rapid Analytics Response to the asthma treatment Crisis." It's scheduled for August 10, 10-11 a.m., in Venetian Marco Polo 701..

Reps. Jason Smith, R-Mo., and Josh Gottheimer, D-N.J., introduced legislation this week to ensure Medicare enrollees have expanded access to telehealth.HR 3447, or the "Permanency for Audio-Only Telehealth Act," would allow for Medicare coverage of audio-only telehealth services after the asthma treatment public health emergency. "The asthma treatment ventolin required the U.S. Healthcare system to innovate and embrace every viable method of healthcare delivery. For patients in rural areas back home in Missouri, none have been more beneficial than the expansion of audio-only telehealth," said Smith in a statement.

"This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight," he continued. WHY IT MATTERS As the legislators noted in a press release, the Centers for Medicare and Medicaid Services allowed healthcare providers to offer audio-only telehealth under Medicare and Medicaid plans during the public health emergency. This has allowed rural patients and low-income people, as well as seniors and those with physical limitations, to continue accessing necessary care. However, those flexibilities will expire at the end of the public health emergency, noted legislators, presenting a clear need for long-term policy. In addition to covering audio-only telehealth, HR 3447 would remove geographic and originating site restrictions for Medicare beneficiaries to access audio-only telemedicine.

"The ventolin has created challenges for everyone, but it's also shown us that technology can provide safe and dependable communication between patients and their doctors," said Gottheimer in a statement. "Innovations including telehealth and audio-only capabilities will improve efficiency, reduce costs, and increase access to health care providers – especially for our seniors and our rural communities," he added. THE LARGER TREND Health equity advocates have repeatedly pointed to the need for audio-only telehealth coverage, given the lack of access to affordable and reliable broadband throughout much of the country. President Joe Biden's administration has taken some steps to address that connectivity need. But in the meantime, other legislators have introduced similar bills that would focus on covering virtual care without a video component.

Earlier this year, members of Congress put forth legislation that would allow providers to offer audio-only services to Medicare Advantage patients, garnering praise from America's Health Insurance Plans. "The bipartisan legislation is another example of how the public and private sector can work together to improve healthcare affordability and access for all Americans," AHIP wrote in a statement. ON THE RECORD "During the asthma treatment ventolin, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits," said Andres M. Gilberg, senior vice president of government affairs for the Medical Group Management Association. "The need for these services will not disappear upon the conclusion of the asthma treatment public health emergency, but the ability to deliver them to Medicare beneficiaries will without congressional action," Gilberg said."Patients should not be penalized for living far away from healthcare facilities or living in areas with inadequate Internet access," he added.

Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Community Health Network, based in Indianapolis, Indiana, faced three engagement problems – a lack of automation, a lack of personal or disease-specific communications and tremendous variation due to point solutions.THE PROBLEMCommunicating with patients was completely driven by live telephone interactions. It was clear the health system needed a more automated solution for appointment reminders and other messaging, for important touchpoints, like when a patient leaves the hospital or emergency department, said Dr. Patrick McGill, executive vice president and chief analytics officer at Community Health Network."In addition, asthma treatment created another barrier to patient communication, as the office staff was saturated with other duties," he said.

"In the few automated solutions that Community Health Network did deploy, there remained a significant amount of manual touching for the communications."Nursing leaders are encouraged, on patients in their unit, to understand how their care and experience is going, if the patient has any acute needs, and how the staff are performing," he continued. "Throughout Community Health Network there was tremendous variation in the nurse leader rounding process. Every nursing leader seemed to do it differently, asking different questions, which left us with no way of tracking compliance and determining which leaders were actively rounding on their patients."PROPOSALCommunity Health Network was interested in a comprehensive, enterprise vendor to help solve all of these problems – lack of automation, lack of personalization and variation in practices.In addition to programs that had a solution in place, Community Health Network wanted to expand its digital solutions consistently across the entire network. Transitioning to a single vendor with a single platform created efficiencies in execution and cost savings, and allowed for enterprise standardization versus each department or area having their own solution, McGill said."We are on track to prevent 2,992 inpatient days due to readmission."Dr. Patrick McGill, Community Health NetworkMost important, it allowed for a consistent patient experience, he added.The health system decided to turn to health IT vendor CipherHealth.MEETING THE CHALLENGE"CipherHealth technology was deployed in several areas – nurse leader rounding, patient appointment reminders, asthma treatment screening pre-appointment calls and post-discharge call-backs," McGill said.

"In nurse leader rounding, we initially deployed a standard digital tool at one hospital for nursing leaders to round on patients in the unit and ask uniform questions with documented responses allowing for consistent follow-up, measurement of areas of opportunity, and increased patient satisfaction and engagement due to consistent leader interactions."It allowed more real-time "voice of the customer" to be captured, he added."In patient appointment reminders, patients are texted or receive an automated call based on their preferences five days and two days prior to their appointment," McGill explained. "This allows them to conveniently confirm or cancel, and allows us to reduce no-shows. Having an automated system allows for reduced staff time on calling patients since this was an entirely manual process prior to the implementation of CipherHealth."The asthma treatment ventolin has introduced another need, which is to screen patients for asthma treatment symptoms prior to their arrival for an appointment. Prior to CipherHealth's tool, this was entirely manual and took several hours per day of office staff to screen and confirm patients prior to their appointment. It also generated an increased call volume since many patients were not reached on the first attempt.Then came post-discharge callbacks."After a patient leaves the hospital or ED, they'll receive a call to evaluate their status, determine if they have any acute needs following the hospitalization or ED visit, and ask if they received all of the follow-up services ordered during their care," McGill said."Prior to CipherHealth, these calls were manually completed by a nurse, using up significant time and resources.

Additionally, we had different teams of nurses calling the patients and had varying but overlapping questions."The population health team, for example, had one set of questions, while the patient experience team had a completely different set."Finally, the questions were often generic and might not apply to a specific patient's circumstances," he added. "With the new solution, all these problems were solved – one team with disease-specific and standard questions managed automated calling and only needed to call the patient manually when a specific need was identified. This allowed faster person-to-person connections, as well as faster and easier issue resolution."RESULTSThe results achieved so far have been powerful across several KPIs."We saw a 1.2% reduction in no-show rates after implementing CipherOutreach," McGill reported. "Across five hospitals, that nets out to an additional almost 40,000 appointments. We sent out 1.55 million patient reminders, with 1.2 million successfully reaching their recipients.

Our pediatrics specialty showed the highest engagement, with a 92% reach rate. Across all specialties, we received a response rate of 41%, with 94% of respondents confirming their appointments."Then there was the impact on annual revenue."With average net revenue per visit at $78, our reduced no-show rate equaled real dollars," he noted. "With just shy of 40,000 appointments that otherwise would have been no-shows, we added an estimated $3.1 million to our annual revenue, just from reducing appointment no-shows."Further, the health system achieved lowered readmissions."Our patients who received post-discharge outreach were 32% less likely to be readmitted following their initial hospitalization or ER discharge," McGill said. "Between July 1, 2020, and December 31, 2020, we had 1,240 actual 30-day readmission inpatient days. Without leveraging post-discharge outreach, we estimate those inpatient days would have jumped to 3,220, meaning that on an annual basis, we are on track to prevent 2,992 inpatient days due to readmission."The health system also made progress on staff recognition and satisfaction.

After battling the ventolin for a year, staff members are exhausted, so the health system has been trying to find every opportunity it can to honor their hard work. CipherHealth's Caregrams functionality allows patients to nominate staff members deserving of recognition. So far, 1,000 staff members have been honored through Caregrams.ADVICE FOR OTHERS"First, find a partner that is – and will act like – a partner," McGill advised. "There are many companies out there in this digital space selling solutions but not partnerships. Second, work with a partner that offers enterprise-wide solutions – inpatient, outpatient, ED, etc.

Third, there is a balance between automation and customization. You need to find a partner that can do both."Any great partner will be willing to truly dive into the organizational struggles and develop solutions if they do not currently have an offering, although in our experience, many companies will say they do this in order to make a sale," he concluded. "Do your homework and investigate."Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.[Note.

This piece has been updated to include comments from Zocdoc.]The medical scheduling site Zocdoc published a letter this week describing a programming error that allowed patient information to be exposed to providers in an unauthorized manner. As Zocdoc explained, the bugs allowed practice staff members to access the vendor's system after their login information was intended to be limited. "Based on our investigation, we do not believe that any misuse or unauthorized access to unsecured personal information has occurred, or that any Zocdoc systems were compromised," said Zocdoc representatives in an email to Healthcare IT News after publication."Out of an abundance of caution, and out of respect for and our continued commitment to compliance with all regulatory requirements, we are notifying affected individuals and practices of this issue," they added.WHY IT MATTERS As Zocdoc explained in its letter, each practice registered with Zocdoc receives usernames that allow staff members to access its Provider Portal. There, providers can view appointments and other information furnished by patients when booking. "Beginning in August 2020, we learned of programming errors that allowed some past or current practice staff members to access the Provider Portal after their usernames and passwords were intended to be removed, deleted or otherwise limited," read the letter.

The company noted that the practices have their own obligations to maintain patient security and confidentiality. Any personal information would include name, email address, phone number and appointment history, as well as insurance member ID, social security number and any relevant medical history provided to the practice via Zocdoc. The information would not have included credit card numbers, debit card or PINs, bank account information, radiological or diagnostic reports or any medical records. "These were not vulnerabilities exploitable by any third parties. Rather, this incident is specific to the access rights of our provider client accounts," said Zocdoc representatives.Zocdoc noted that it launched an internal investigation to repair the errors and that it is offering a year of identity theft protection through Experian IdentityWorks for affected patients.

According to TechCrunch's Zach Whittaker, about 7,600 users across the United States were affected. Whittaker also notes that Zocdoc reported a similar incident in 2016. "We repaired these errors, and the affected usernames can no longer access our system," said the vendor.THE LARGER TREND Although the highest-profile patient-information breaches of late have involved ransomware, human error has also led to some major missteps.Early this month, for example, an employee of the Wyoming health department accidentally uploaded the asthma treatment, influenza and blood alcohol test results for more than a quarter of the state's population to a public-facing website. Three years ago, a Blue Cross employee uploaded a file containing member information to a website where it remained visible to the public for three months. ON THE RECORD "We have … strengthened our security practices and are taking appropriate steps to prevent an incident like this from recurring," said Zocdoc in the letter.

"We will continue to regularly audit our system security and take action to enhance it." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.New York City was hit hard and fast by asthma treatment in early 2020. At NYU Langone Health, the crisis was met with a swift, multi-pronged, analytics response. Clinical informaticists and analytics teams worked closely with hospital operations and institutional leadership to build a source-of-truth asthma treatment dataset for the institution, to identify and define key metrics, and build near-real-time dashboards.Additionally, the teams constructed a de-identified asthma treatment data repository to support the many research projects related to asthma treatment and enhance education around informatics and data use.Communicating data and analytics needs"NYU Langone Health has existing processes in place that allow for operational leadership to communicate data and analytics needs to our medical center IT department," said Dr.

Eduardo Iturrate, health IT safety officer and medical director for enterprise data and analytics at NYU Langone Medical Center."These processes include several committees that allow leadership to identify and describe needs to MCIT, as well as a reporting and metrics committee, which serves as the venue for governance and to rigorously define metrics to a degree that can be operationalized by reporting analysts to be built and then flow to the health system's existing dashboard infrastructure," he added.The dashboard infrastructure is another essential piece of the puzzle that allows for rapid development of consumable business intelligence for health system leadership, he said."The dashboard system is a flexible, extensible system that has permission schemes built in to allow for the creation of publicly accessible dashboards as well as dashboards with a limited distribution list as defined by operations," he said."Finally, our underlying enterprise data warehouse is the backbone data infrastructure that underpins our systems ability to use data and analytics to inform leadership."Several institutional challengesThe development of the de-identified asthma treatment data repository required surmounting several institutional challenges, some of them technical and others related to getting bureaucratic approval to move forward."In order to proceed, we needed to present the idea of developing the dataset, and in particular we needed to define the scope of use that we were proposing," Iturrate explained. "This was reviewed by our architecture governance committees, as well as by our legal and compliance departments."We developed a data use agreement for this effort that formalized the scope of use and, in collaboration with these groups, determined that we would restrict sharing of the dataset to only members of the NYU Langone Health community."This limitation guided our technical approach to de-identification and allowed us to define a degree of de-identification along the spectrum toward anonymization that satisfied institutional concerns related to exposing patient health information," he added."We also then needed to build tools and infrastructure to allow users to have secure access to the dataset, and to that end we created an approach to use a virtual desktop with pre-installed data analysis tools."Finally, staff need to build out the support and systems to accommodate requests for the addition of data elements to the system and for the development and sharing of derived data elements, he said.A big impactIn the end, these dashboards and de-identified data repositories could have quite an impact."Having operational dashboards with timely and accurate data about the patient care conditions that affect the organization allows operational leadership to make informed decisions regarding resource allocation and strategic planning," Iturrate said."This was crucial during the rapidly changing landscape of the evolving asthma treatment crisis, which forced our health system (and others) to reinvent itself rapidly to respond to the crisis."The de-identified data repository expands access to clinical data to the research community by providing a degree of self-service access to clinical data," he continued. "This approach improves the bottleneck that can exist related to requests for clinical data that are limited by the number of available data analysts."Additionally, the de-identified data repository allowed staff to encourage collaboration and make connections between researchers and data scientists across all campuses and many academic departments of the large health system. The data repository allowed for the generation of several research manuscripts that may have been held up by usual research request processes.Iturrate will offer more detail during his HIMSS21 session, "Case Study. Rapid Analytics Response to the asthma treatment Crisis." It's scheduled for August 10, 10-11 a.m., in Venetian Marco Polo 701..

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A study published this week in the Journal of the American Medical Informatics Association found that, although electronic health record adoption is can i buy ventolin over the counter uk essentially ubiquitous, critical access hospitals lag behind in is proair same as ventolin advanced use functions. "As EHR adoption has become universal, the need to measure hospital use of advanced EHR functions that go beyond the digitization of clinical data to deliver value is proair same as ventolin to patients and clinicians grows increasingly important," wrote the authors. "Our measures of advanced EHR use in the domains of patient engagement and clinical data analytics show lower levels of adoption than basic EHRs," they added. WHY IT MATTERS More than a decade after the passage of the Health Information Technology for Economic is proair same as ventolin and Clinical Health Act, basic EHRs are evenly distributed across various types of hospitals in the United States. Researchers note, however, that there was early evidence of a divide in which critical access hospitals were less likely than non-CAHs to have implemented patient engagement and clinical data analytic tools is proair same as ventolin.

"Patient engagement tools facilitate efficient communication, improve access, and enable interoperability for care coordination, while clinical data analytics capabilities give hospitals the ability to leverage the data in their EHRs for quality improvement, research, and targeting high-risk patients with care management interventions," wrote the researchers. "Both is proair same as ventolin domains are integral to broader U.S. Health system goals," they added.The team set out to examine whether that divide has persisted, examining the most recently available data is proair same as ventolin from the American Hospital Association Annual Survey of Hospitals IT Supplement. The team found that in 2018, 98.3% of hospitals had adopted either a basic or comprehensive EHR, with no difference in adoption rates across CAH and non-CAH hospitals. However, 63.3% of non-CAHs reported advanced is proair same as ventolin EHR use for patient engagement, as compared with 46.6% of CAHs.When it comes to clinical data analytics, 64.5% of non-CAHs reported advanced use, versus 32% of CAHs.Between 2014 and 2018, the adoption gap for advanced use functions widened.

The authors note that the HITECH Act included provisions focused on less-resourced hospitals, and largely on facilities' adoption of new EHRs, rather than on improving existing systems.In addition, many patient engagement functions (such as appointment scheduling) are possible over the phone, so CAHs may not prioritize enabling them digitally. When it comes is proair same as ventolin to clinical data analytics, workforce capacity constraints and technical expertise may limit adoption. "Regardless of is proair same as ventolin what is driving these gaps, they are problematic, as they have implications for patient care," wrote researchers. "Specifically, without the tools to measure quality, stratify patient populations, and more generally leverage clinical data from EHRs for organizational priorities, CAHs will likely struggle with undertaking and tracking quality improvement efforts, as these capabilities are prerequisites to many quality improvement and population health goals," they continued.In response, policymakers could allocate targeted support to promote advanced EHR use, as well as consider advanced analytic function implementation standards. THE LARGER TREND More than ten years after the passage of the HITECH Act, stakeholders are contemplating lessons learned – is proair same as ventolin and reflecting on changes that could prevent future hiccups.In a study published earlier this year, policy experts said that they had underestimated the impact of widespread EHR use on clinician burnout at the time of the law's passage.

On the other hand, fears around patient is proair same as ventolin harm due to alert dependence and identity theft were classified as overblown. The experts in that study also pointed to two unanticipated HIT outcomes over the past decade. EHR vendor monopoly and minimal user is proair same as ventolin experience improvement. ON THE RECORD "While EHR adoption has reached parity at a high level is proair same as ventolin across U.S. Acute care hospitals, the advanced use divide in advanced use among CAHs and non-CAHs has not been diminished in recent years," wrote researchers.

"CAHs continue to lag in patient engagement functions, and have fallen further behind is proair same as ventolin in clinical data analytics. These functions underpin many quality improvement and population health efforts, and may prevent patients who receive care at CAHs from benefiting from a fully digitized healthcare system," they added. Kat Jercich is senior editor of is proair same as ventolin Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.In a class action filed this week, healthcare workers alleged that their Amazon Alexa-enabled devices may have recorded their conversations – including potentially protected information.Some of the plaintiffs, who include a substance abuse counselor and a healthcare customer service representative, say they work with HIPAA-protected information.

Others say they have private conversations with patients.All four raise concerns that Alexa may have captured sensitive information without their intent. "Amazon’s conduct in surreptitiously recording consumers has violated federal and state wiretapping, privacy, and consumer protection laws," alleged the lawsuit, which was filed in the Western District of Washington federal court. Amazon did not respond to requests for comment.WHY IT MATTERS The plaintiffs' complaints are twofold. They say that users may unintentionally awaken Amazon Alexa-enabled devices and that Amazon uses human intelligence and AI to listen to, interpret and evaluate these records for its own business purposes. "Despite Alexa’s built-in listening and recording functionalities, Amazon failed to disclose that it makes, stores, analyzes and uses recordings of these interactions at the time plaintiffs’ and putative class members’ purchased their Alexa devices," read the lawsuit.The four plaintiffs, all of whom work in the healthcare industry in some capacity, say they either stopped using Alexa devices or purchased newer models with a mute function out of concern that their conversations may be unintentionally recorded, stored and listened to.The suit cites studies, such as one from Northeastern University, that have found smart speakers are activated by words other than "wake words." For Amazon devices, researchers found activations with sentences including "I care about," "I messed up," and "I got something," as well as "head coach," "pickle" and "I'm sorry."Some of the activations, researchers found, were long enough to record potentially sensitive audio.In 2019, Amazon announced an "ongoing effort" to ensure that transcripts would be deleted from Alexa's servers after customers deleted voice recordings.

Amazon executives also noted in 2020 that customers can "opt out" of human annotation of transcribed data and that they can automatically delete voice recordings older than three or 18 months."By then, Amazon’s analysts may have already listened to the recordings before that ability was enabled," argues the lawsuit. THE LARGER TREND Amazon has made inroads over the past few years when it comes to implementing voice-enabled features aimed at addressing medical needs.But some users still express skepticism about using voice technology and AI for health issues. And in December 2019, privacy organizations in the United Kingdom raised concerns about a deal that allowed Amazon to use NHS data. ON THE RECORD "Plaintiffs expected [their] Alexa Device to only 'listen' when prompted by the use of the 'wake word,' and did not expect that recordings would be intercepted, stored, or evaluated by Amazon," read the lawsuit. "Had Plaintiffs known that Amazon permanently stored and listed [sic] to recordings made by its Alexa device, Plaintiffs would have either not purchased the Alexa Device or demanded to pay less," it continued.

Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Technology leaders at U.S. Health systems have learned a lot this past year-plus. They've gotten better with adaptability and rapid implementation of new workflows.

Some have learned that 24- to 72-hour downtime processes are inadequate to prepare for a 23-day outage. And they've discovered that teams that don't usually spend time together can co-create innovative fixes for urgent challenges.Among some other lessons learned by IT execs during the past year and a half. The importance of IT teams partnering with clinical, financial and operational teams at a moment's notice, and the difficulty of hiring key staff during a crisis that needed all hands on deck.In this 11th installment in Healthcare IT News' Health IT Lessons Learned in the asthma treatment Era feature series, we speak with three health IT leaders from points across the map, including:Dr. Andrew W. Burchett, chief medical information officer at Avera Health, based in Sioux Falls, South Dakota.John Gaede, director of information services at Sky Lakes Medical Center in Klamath Falls, Oregon.Beth Lindsay-Wood, CIO at Moffitt Cancer Center in Tampa, Florida.(Click here to access the portal to see all the features in this series of articles.)Working with new workflowsBurchett of Avera Health said one of the lessons he learned during the ventolin concerned the adaptability and rapid implementation of new workflows."Typically, we move at glacial pace as we look to begin using new technologies and solutions," he observed.

"With the ventolin, we were able to rapidly virtualize our care environments, continue to provide excellent care to our patients and keep our staff working."Virtual care has continued to be part of our new normal," he continued. "We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day. Both patients and providers prefer virtual for certain types of visits. Interim follow-ups, medication management, quick visits to name a few.""We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day."Dr. Andrew W.

Burchett, Avera HealthThe convenience of attending these visits from home, work or even in a parking lot has been satisfying, he noted."In our rural environment, this also saves patients a tremendous amount of time on the road and keeps them in the workforce," he added. "The behavioral health service line continues to utilize virtual care in high numbers. They have seen better patient engagement, lower no-show rates and higher provider and patient satisfaction."Hospital at homeAnother lesson Burchett learned was big. Hospital-level care can indeed be provided in the home."We were able to serve more than 5,000 patients in our hospital-at-home service," he reported. "Daily census was nearly 500 at peak with more than 100 of those on oxygen.

We were able to use remote patient monitoring software with peripherals to care for patients in a more robust way in their homes, protecting our emergency departments, hospitals, urgent cares and clinics."This also helped preserve personal protective equipment and preserve precious capacity in our already full hospitals," he continued. "For those patients who had increasing care needs, a controlled admission to the hospital was achieved through our transfer center and EMS, avoiding the emergency department visit and exposure."Avera Health has closed down the asthma treatment hospital-at-home program in the last month because of exceedingly low numbers in the region."With this experience, we can confidently transition these efforts and participate in the new CMS Acute Hospital Care at Home Program," he said. "Another area of growth is our remote gestational diabetes management program, or e-GDM. Remote monitoring allows more continuous engagement rather than episodic care."With significantly improved glycemic control, these patients have better perinatal outcomes, with lower preterm birth rates, lower Cesarean section rate, lower rate of large for gestational age babies and fewer as well as shorter neonatal intensive care unit stays," he added.Staff members are able to centralize the care in the tertiary care center and one regional facility. As they have seen with other virtual services, these patients are saving thousands of miles in travel and hundreds of hours of time, thereby keeping them in the workforce and lowering child care costs.

Ultimately, the cost of ventolin in usa organization has healthier moms and babies, he said.Dealing with a ransomware attackOne health IT lesson learned at Sky Lakes Medical Center in the past year – one that surpassed the unusual setting that asthma treatment brought to the organization – was the realization at the height of the ventolin that the organization's 24- to 72-hour downtime processes were inadequate to prepare for a 23-day outage."Our vice president for patient care and chief nursing officer said, 'We have worked downtime out of our processes.' This statement captures a stunning learning. IT is so often seen as an unrecoverable expense to the bottom line."John Gaede, Sky Lakes Medical Center"In October of 2020, the Sky Lakes organization, which includes the medical center, a cancer treatment facility, and primary care and specialty clinics, experienced a tip-of-a-spear Ryuk ransomware attack that hit the healthcare industry with blunt force trauma," said Gaede of Sky Lakes Medical Center. "Our vice president for patient care and chief nursing officer said, 'We have worked downtime out of our processes.' This statement captures a stunning learning. IT is so often seen as an unrecoverable expense to the bottom line."What we learned is that the investments done over time in IT do in fact yield organizationally dependent efficiencies that we quickly forget about," he continued. "When Ryuk took all systems offline, all the many employees required to process orders and results, prescribe medications, and transport everything related to these items were 'worked...out of our process' and instead replaced by various technologies."The organization no longer had runners in the emergency department to transport specimens to lab services.

It no longer had unit secretaries on the various medical, surgical and intensive care units to process orders and results. It no longer had runners in pharmacy to transport medications."All these employees were 'worked … out of our processes,'" he said. "We no longer had these resources for the day-after-arduous-day of operations held hostage by a 100% paper downtime after decades of electronic medical record use. IT does make us more efficient and that is why we make these investments."The way the organization plans on applying this lesson today and beyond is by capturing, documenting and implementing the salient learnings from each clinical, financial and other operations workflow."After six months of recovery from the 23-day outage, each department solidified the deficiencies and the inadequacies of our 24- to 72-hour policies and procedures," Gaede said. "We lacked the real-world understanding of a longtime outage of IT.

When every system in your healthcare system is offline, your organization must be able to operate differently."We have just officially recovered from the ransomware attack and we are now meeting with each department's leadership and frontline staff to capture, document and then categorize the information in a playbook, should something like this ever happen again," he explained. "This will allow us to put into play these key learnings at the front-end of an IT downtime disaster, rather than learning about our inefficiencies and deficiencies, and building our solutions, on the fly."Exhilarating agilityA big lesson for Lindsay-Wood of Moffitt Cancer Center centered on agility."There is nothing like a good disaster to bring people together in a different way," she said. "It was exhilarating to see teams that don't usually spend time together creating solutions to address an urgent need. One specific area for us was virtual visits, which we had in place prior to the stay at home order."We recognized immediately that to scale dramatically to ensure we can keep treating our patients we had to do something dramatically different as our current telemedicine platform could not scale rapidly for a number of reasons," she continued. "The great ideas come from amazing places in the organization and sometimes leadership needs to get out of the way."Beth Lindsay-Wood, Moffitt Cancer Center"We increased visits by 5,000% in two weeks.

In order to do that, we used a well-known communications platform as a base. It was easy to use for patients and providers with minimal training, had robust architecture, and is secure and already used in our organization."In addition to preparing the platform and users, staff rapidly developed software to integrate both their EHR and patient portal for scheduling, notifications and other key requirements."A multidisciplinary team worked on all aspects of rolling all this out extremely fast. It was amazing to watch," she said. "Great ideas were fostered, everyone engaged to see what they could do to help. All areas of IT were in the mix, platform support and new development leveraging an agile framework for rolling out changes, running virtual command centers, provider and patient training, at the elbow support, some of it virtual as well."We knew it was critical to get this online within the first few weeks to ensure our cancer patients had no delays in care," she continued.

"We used a huddle format twice a day in IT that included all areas to foster ideas, garner support and maintain focus. There were many examples of this during asthma treatment, but this stands out as an early example of how much we can accomplish in a short period of time if everyone is working together with focus."Lindsay-Wood and her team are leveraging a model called radical interdependence (RI) to ensure they engage and empower teams to work together."The great ideas come from amazing places in the organization, and sometimes leadership needs to get out of the way. And the best thing we can do is let teams work together 'without walls' or differing priorities, and allow failure of ideas," she said. "My vision of without walls is having a big open space with mobile desks that allow people to join teams to solve specific problems."But not just new and innovative initiatives, all work," she added. "This is a mantra for our new Center for Digital Health, a new organization that includes IT, health data services and digital innovation.

The idea is that radical interdependence doesn't have any heroes. It is all of us that bring their specific skills to the table to evaluate ideas and solve problems, and get egos out of it."She sees the matrix structure as more important than the formalized reporting structures, ensuring they do not duplicate skills across organizations, reducing siloes and relying heavily on one another in different ways to achieve the most important work staff can do to prevent and cure cancer."It really is about the mission and transforming the organization," she said.Speedy teamworkAnother health IT lesson Sky Lakes learned in the past year, spurred by the unusual setting and requirements of 2020, has to do with never-used-before technologies that were brought online through "the resiliency, creativity, thoughtfulness, compassion and ingenuity of our IT teams partnering in close coordination with clinical, financial and operational teams in a moment's notice," said Gaede of Sky Lakes Medical Center."A prime example, experienced by many in our industry in the past year, was acknowledging that our telehealth capabilities were not robust enough," he recalled. "In response, we built out full-scale telemedicine technologies and workflows literally over a weekend. Our teams discussed rolling out telehealth on a Thursday morning, looked at various technologies that Thursday afternoon, discussed the technologies with clinical, financial and operational leaders late Thursday afternoon, engaged a vendor the next day, and went live on Monday morning."This kind of innovation is typically a nine-month project, coordinating all the people, processes and technologies," he added. "Not so in 2020, when it was a weekend process."Gaede and his team will be applying this lesson by starting with an understanding that crises can breed ingenuity."The idea here is to no longer wait for the crises to think outside the box, but rather to dream it, create it and implement it now," he said.

"We had to have our infrastructure in place and be able to scale rapidly. Setting up overnight drive-through clinics, overnight call centers and the like all demanded a robust investment in IT and technologies that allow scale."Fortunately, he added, Sky Lakes Medical Center supported investments in key technologies in the years prior that allowed this scale."You never know the curve ball life will throw, and having the right technologies and vendor partnerships in place are literal lifesavers," he said.Hiring under difficult circumstancesOn another front, Lindsay-Wood of Moffitt Cancer Center was the interim CIO when asthma treatment arrived. In January 2020, she had just received approval for funding to dramatically increase staffing in IT in order to rapidly mature the IT group and address gaps in services and tools."I mean adding 50% of our current workforce into the organization," she stressed. "Moffitt was growing very rapidly, and we needed to grow and mature rapidly to support our strategic plan along with a very complex environment with a strong research mission and our highly specialized patient care environment due to our specialized oncology services."It was very difficult to hire during asthma treatment and required a tremendous amount of perseverance by our leaders in IT and our HR team to move that along," she continued. "We have onboarded well over 100 people during the year of asthma treatment, most of which was all virtual from recruitment through orientation."Much of IT was virtual until early April of this year, which was the first time leaders saw many of their team members."It was great meeting people in person, working in our new expanded building space, creating our new culture – all driven by our maturity efforts," Lindsay-Wood said.

"We keep to huddles and rounds to ensure constant communication on our efforts to improve our core processes, implement our new IT tools, increase team member education and development, and learn to run IT as a business."All of that work was happening while we addressed asthma treatment-related projects, several strategic and operational initiatives (opening a new ambulatory center, building a new hospital, etc.) very successfully," she continued. "It has been a challenge and a delight to see the progress we are making on a number of fronts, forging partnerships within the organization, and constantly improving our core metrics – keeping our eye on the ball."While the staff was working hard on the maturity efforts, the organization just kept moving and the staff stayed engaged, which was so important to advancing the mission, she added.Getting things done"The lesson is that you don't let something like a ventolin become the focus and make that a reason not to get important things done," she said. "It could have happened easily – putting our fortification efforts on hold, halting recruitment efforts, slowing down strategic initiatives, cancelling important projects."We really didn't do that for the most part," she continued. "The organization was really smart, and implemented cost savings initiatives extremely early, which put us in a more favorable position. I think we all hoped that the ventolin would be short and merciful, but our leaders planned for a long haul and took early steps to manage it."No one came out unscathed in this.

Everyone had a tremendous challenge to keep moving forward, she said."Our research had to continue. Our clinical trials are critical to our patient outcomes, and our patient complexity required us to operate as close to normal as possible," she concluded. "There was no playbook for much of this, but we – all of healthcare – have one now."Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.The rapid push to digitalization and consumerization in healthcare means providing a seamless experience for patients across in-person, phone and online contacts.The financial and commercial sectors figured out long ago how to manage huge volumes of confidential customer data and provide a seamless experience across phone, online and in-person contacts.Christen Castellano, vice president of customer experience channels at Banner Health, is tasked with making it easier to receive care for their hundreds of thousands of patients.

She is scheduled to speak about her work at HIMSS21.Castellano is leading the development and rollout of a digital health transformation initiative to deliver a modern, enterprise-wide platform to patients and physicians through a digital front door."The intention improves access to care and improves convenience for customers and for team members," she said. "By making it easy to find a doctor and schedule online, we’ve substantially improved both."She noted research firm Gartner ranked Banner Health seventh in ease of use and the health system has seen a 92% increase in appointments booked online over the last year."The increase in self-service appointment scheduling also allows more capacity for populations, such as seniors and the underserved, to access person-assisted appointments by phone, so the lift is across both channels," she said.Because all health systems have electronic health records that hold hundreds of information fields for each patient, the most important decision to be made is how much of the EHR data is "just enough" to deliver personalized communications without compromising privacy.At Banner, each patient has more than 1,000 fields in their EHR, she said, but they only feed 14 of those into their customer database and then enrich it with geo demographics and transaction data.She noted the biggest interoperability challenge typically relates to the company’s middleware and how it subscribes and publishes data to its legacy systems and other applications."Our approach is similar to the financial industry, which also has confidential and highly regulated data," said Castellano. "Customers expect and deserve a frictionless experience in all industries, including healthcare, so we’re creating digital environments to meet people where they are."She said the aim is to serve multiple stakeholders across multiple channels. As a result, the transformation has shaped both Banner’s organic and inorganic growth strategies."It is also foundational to retention and engagement for both customers and staff, which are critical to successfully executing our growth plans," she said. "A robust enterprise-wide digital platform brings convenience and connection at scale for patients and team members."Christen Castellano will share some digital front door best practices during her HIMSS21 session, "Creating a Seamless Customer Healthcare Experience Through Digital Transformation." It's scheduled for Tuesday, August 10, from 4:15 p.m.-5:15 p.m., in room Murano 3201A.

Nathan Eddy is a healthcare and technology freelancer based in Berlin.Email the writer. Nathaneddy@gmail.comTwitter. @dropdeaded209HotDoc, a Melbourne-based patient engagement platform provider, has partnered with two major hospitals in Australia for vaccination booking projects.WHY IT MATTERSThis week, Austin Hospital in Melbourne started using HotDoc's complete scheduling solution and tools for eligibility screening and stock management for asthma treatment inoculations. The hospital aims to schedule approximately 1,000 asthma treatment vaccination appointments each day.HotDoc said its platform will also be deployed at St. Vincent's Hospital in Sydney for booking administration of influenza vaccination for staff, featuring walk-ins, appointment calendars and online consent forms.

It will also enable the hospital to conduct online patient verification check enhancements through Medicare Check and the submission of immunisation records through its Australian Immunisation Register-integrated platform.HotDoc estimates that its platform has enabled 2.5 million appointments for asthma treatment vaccinations to date.THE LARGER TRENDTechnology providers rose to the occasion to support vaccination initiatives across the world. Notable players in this space include Zocdoc and Microsoft. Luma Health in January introduced its range of solutions to enable rapid treatment delivery and operation, including a scheduling tool.In the UK, medtech startup DrDoctor helps streamline the vaccination of over 1 million NHS workers through its QuickBook solution.Bahrain was reportedly the first country to allow asthma treatment vaccination appointments via a mobile app. Since January, citizens of the country have been able to schedule their free immunisations through the BeAware app.ON THE RECORD"Working with hospitals to ensure their staff are vaccinated is a real thrill for HotDoc and aligns further with our mission to improve the healthcare experience for everyone in Australia. We look forward to long partnerships with these hospitals into the future," HotDoc CEO Ben Hurst said in a statement..

A study published this week in the Journal of the American Medical Informatics Association found http://theorganicrabbit.com/dehydrated-fruit-natures-candy/ that, although electronic health record adoption can i get ventolin over the counter uk is essentially ubiquitous, critical access hospitals lag behind in advanced use functions. "As EHR adoption has become universal, the need to measure hospital use of advanced EHR functions that go beyond the digitization of clinical data to deliver value to patients and clinicians grows increasingly important," wrote the authors can i get ventolin over the counter uk. "Our measures of advanced EHR use in the domains of patient engagement and clinical data analytics show lower levels of adoption than basic EHRs," they added.

WHY IT MATTERS More than a decade after the passage of can i get ventolin over the counter uk the Health Information Technology for Economic and Clinical Health Act, basic EHRs are evenly distributed across various types of hospitals in the United States. Researchers note, however, can i get ventolin over the counter uk that there was early evidence of a divide in which critical access hospitals were less likely than non-CAHs to have implemented patient engagement and clinical data analytic tools. "Patient engagement tools facilitate efficient communication, improve access, and enable interoperability for care coordination, while clinical data analytics capabilities give hospitals the ability to leverage the data in their EHRs for quality improvement, research, and targeting high-risk patients with care management interventions," wrote the researchers.

"Both domains are can i get ventolin over the counter uk integral to broader U.S. Health system can i get ventolin over the counter uk goals," they added.The team set out to examine whether that divide has persisted, examining the most recently available data from the American Hospital Association Annual Survey of Hospitals IT Supplement. The team found that in 2018, 98.3% of hospitals had adopted either a basic or comprehensive EHR, with no difference in adoption rates across CAH and non-CAH hospitals.

However, 63.3% of can i get ventolin over the counter uk non-CAHs reported advanced EHR use for patient engagement, as compared with 46.6% of CAHs.When it comes to clinical data analytics, 64.5% of non-CAHs reported advanced use, versus 32% of CAHs.Between 2014 and 2018, the adoption gap for advanced use functions widened. The authors note that the HITECH Act included provisions focused on less-resourced hospitals, and largely on facilities' adoption of new EHRs, rather than on improving existing systems.In addition, many patient engagement functions (such as appointment scheduling) are possible over the phone, so CAHs may not prioritize enabling them digitally. When it comes to clinical data analytics, workforce capacity constraints and technical can i get ventolin over the counter uk expertise may limit adoption.

"Regardless of what is driving these gaps, they can i get ventolin over the counter uk are problematic, as they have implications for patient care," wrote researchers. "Specifically, without the tools to measure quality, stratify patient populations, and more generally leverage clinical data from EHRs for organizational priorities, CAHs will likely struggle with undertaking and tracking quality improvement efforts, as these capabilities are prerequisites to many quality improvement and population health goals," they continued.In response, policymakers could allocate targeted support to promote advanced EHR use, as well as consider advanced analytic function implementation standards. THE LARGER TREND More than ten years after the passage of the HITECH Act, stakeholders are contemplating lessons learned – and reflecting can i get ventolin over the counter uk on changes that could prevent future hiccups.In a study published earlier this year, policy experts said that they had underestimated the impact of widespread EHR use on clinician burnout at the time of the law's passage.

On the other hand, fears around patient harm due to alert can i get ventolin over the counter uk dependence and identity theft were classified as overblown. The experts in that study also pointed to two unanticipated HIT outcomes over the past decade. EHR vendor monopoly and minimal can i get ventolin over the counter uk user experience improvement.

ON THE RECORD "While EHR adoption has reached can i get ventolin over the counter uk parity at a high level across U.S. Acute care hospitals, the advanced use divide in advanced use among CAHs and non-CAHs has not been diminished in recent years," wrote researchers. "CAHs continue to lag in patient engagement functions, and have fallen further behind in clinical data can i get ventolin over the counter uk analytics.

These functions underpin many quality improvement and population health efforts, and may prevent patients who receive care at CAHs from benefiting from a fully digitized healthcare system," they added. Kat Jercich can i get ventolin over the counter uk is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.In a class action filed this week, healthcare workers alleged that their Amazon Alexa-enabled devices may have recorded their conversations – including potentially protected information.Some of the plaintiffs, who include a substance abuse counselor and a healthcare customer service representative, say they work with HIPAA-protected information. Others say they have private conversations with patients.All four raise concerns that Alexa may have captured sensitive information without their intent. "Amazon’s conduct in surreptitiously recording consumers has violated federal and state wiretapping, privacy, and consumer protection laws," alleged the lawsuit, which was filed in the Western District of Washington federal court.

Amazon did not respond to requests for comment.WHY IT MATTERS The plaintiffs' complaints are twofold. They say that users may unintentionally awaken Amazon Alexa-enabled devices and that Amazon uses human intelligence and AI to listen to, interpret and evaluate these records for its own business purposes. "Despite Alexa’s built-in listening and recording functionalities, Amazon failed to disclose that it makes, stores, analyzes and uses recordings of these interactions at the time plaintiffs’ and putative class members’ purchased their Alexa devices," read the lawsuit.The four plaintiffs, all of whom work in the healthcare industry in some capacity, say they either stopped using Alexa devices or purchased newer models with a mute function out of concern that their conversations may be unintentionally recorded, stored and listened to.The suit cites studies, such as one from Northeastern University, that have found smart speakers are activated by words other than "wake words." For Amazon devices, researchers found activations with sentences including "I care about," "I messed up," and "I got something," as well as "head coach," "pickle" and "I'm sorry."Some of the activations, researchers found, were long enough to record potentially sensitive audio.In 2019, Amazon announced an "ongoing effort" to ensure that transcripts would be deleted from Alexa's servers after customers deleted voice recordings.

Amazon executives also noted in 2020 that customers can "opt out" of human annotation of transcribed data and that they can automatically delete voice recordings older than three or 18 months."By then, Amazon’s analysts may have already listened to the recordings before that ability was enabled," argues the lawsuit. THE LARGER TREND Amazon has made inroads over the past few years when it comes to implementing voice-enabled features aimed at addressing medical needs.But some users still express skepticism about using voice technology and AI for health issues. And in December 2019, privacy organizations in the United Kingdom raised concerns about a deal that allowed Amazon to use NHS data.

ON THE RECORD "Plaintiffs expected [their] Alexa Device to only 'listen' when prompted by the use of the 'wake word,' and did not expect that recordings would be intercepted, stored, or evaluated by Amazon," read the lawsuit. "Had Plaintiffs known that Amazon permanently stored and listed [sic] to recordings made by its Alexa device, Plaintiffs would have either not purchased the Alexa Device or demanded to pay less," it continued. Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Technology leaders at U.S. Health systems have learned a lot this past year-plus.

They've gotten better with adaptability and rapid implementation of new workflows. Some have learned that 24- to 72-hour downtime processes are inadequate to prepare for a 23-day outage. And they've discovered that teams that don't usually spend time together can co-create innovative fixes for urgent challenges.Among some other lessons learned by IT execs during the past year and a half.

The importance of IT teams partnering with clinical, financial and operational teams at a moment's notice, and the difficulty of hiring key staff during a crisis that needed all hands on deck.In this 11th installment in Healthcare IT News' Health IT Lessons Learned in the asthma treatment Era feature series, we speak with three health IT leaders from points across the map, including:Dr. Andrew W. Burchett, chief medical information officer at Avera Health, based in Sioux Falls, South Dakota.John Gaede, director of information services at Sky Lakes Medical Center in Klamath Falls, Oregon.Beth Lindsay-Wood, CIO at Moffitt Cancer Center in Tampa, Florida.(Click here to access the portal to see all the features in this series of articles.)Working with new workflowsBurchett of Avera Health said one of the lessons he learned during the ventolin concerned the adaptability and rapid implementation of new workflows."Typically, we move at glacial pace as we look to begin using new technologies and solutions," he observed.

"With the ventolin, we were able to rapidly virtualize our care environments, continue to provide excellent care to our patients and keep our staff working."Virtual care has continued to be part of our new normal," he continued. "We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day. Both patients and providers prefer virtual for certain types of visits.

Interim follow-ups, medication management, quick visits to name a few.""We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day."Dr. Andrew W. Burchett, Avera HealthThe convenience of attending these visits from home, work or even in a parking lot has been satisfying, he noted."In our rural environment, this also saves patients a tremendous amount of time on the road and keeps them in the workforce," he added.

"The behavioral health service line continues to utilize virtual care in high numbers. They have seen better patient engagement, lower no-show rates and higher provider and patient satisfaction."Hospital at homeAnother lesson Burchett learned was big. Hospital-level care can indeed be provided in the home."We were able to serve more than 5,000 patients in our hospital-at-home service," he reported.

"Daily census was nearly 500 at peak with more than 100 of those on oxygen. We were able to use remote patient monitoring software with peripherals to care for patients in a more robust way in their homes, protecting our emergency departments, hospitals, urgent cares and clinics."This also helped preserve personal protective equipment and preserve precious capacity in our already full hospitals," he continued. "For those patients who had increasing care needs, a controlled admission to the hospital was achieved through our transfer center and EMS, avoiding the emergency department visit and exposure."Avera Health has closed down the asthma treatment hospital-at-home program in the last month because of exceedingly low numbers in the region."With this experience, we can confidently transition these efforts and participate in the new CMS Acute Hospital Care at Home Program," he said.

"Another area of growth is our remote gestational diabetes management program, or e-GDM. Remote monitoring allows more continuous engagement rather than episodic care."With significantly improved glycemic control, these patients have better perinatal outcomes, with lower preterm birth rates, lower Cesarean section rate, lower rate of large for gestational age babies and fewer as well as shorter neonatal intensive care unit stays," he added.Staff members are able to centralize the care in the tertiary care center and one regional facility. As they have seen with other virtual services, these patients are saving thousands of miles in travel and hundreds of hours of time, thereby keeping them in the workforce and lowering child care costs.

Ultimately, the organization has healthier moms and babies, he said.Dealing with a ransomware attackOne health IT lesson learned at Sky Lakes Medical Center in the past year – one that surpassed the unusual setting that asthma treatment brought to the organization – was the realization at the height of the ventolin that the organization's 24- to 72-hour downtime processes were inadequate to prepare for a 23-day outage."Our vice president for patient care and chief nursing officer said, 'We have worked downtime out of our processes.' This statement captures a stunning learning. IT is so often seen as an unrecoverable expense to the bottom line."John Gaede, Sky Lakes Medical Center"In October of 2020, the Sky Lakes organization, which includes the medical center, a cancer treatment facility, and primary care and specialty clinics, experienced a tip-of-a-spear Ryuk ransomware attack that hit the healthcare industry with blunt force trauma," said Gaede of Sky Lakes Medical Center. "Our vice president for patient care and chief nursing officer said, 'We have worked downtime out of our processes.' This statement captures a stunning learning.

IT is so often seen as an unrecoverable expense to the bottom line."What we learned is that the investments done over time in IT do in fact yield organizationally dependent efficiencies that we quickly forget about," he continued. "When Ryuk took all systems offline, all the many employees required to process orders and results, prescribe medications, and transport everything related to these items were 'worked...out of our process' and instead replaced by various technologies."The organization no longer had runners in the emergency department to transport specimens to lab services. It no longer had unit secretaries on the various medical, surgical and intensive care units to process orders and results.

It no longer had runners in pharmacy to transport medications."All these employees were 'worked … out of our processes,'" he said. "We no longer had these resources for the day-after-arduous-day of operations held hostage by a 100% paper downtime after decades of electronic medical record use. IT does make us more efficient and that is why we make these investments."The way the organization plans on applying this lesson today and beyond is by capturing, documenting and implementing the salient learnings from each clinical, financial and other operations workflow."After six months of recovery from the 23-day outage, each department solidified the deficiencies and the inadequacies of our 24- to 72-hour policies and procedures," Gaede said.

"We lacked the real-world understanding of a longtime outage of IT. When every system in your healthcare system is offline, your organization must be able to operate differently."We have just officially recovered from the ransomware attack and we are now meeting with each department's leadership and frontline staff to capture, document and then categorize the information in a playbook, should something like this ever happen again," he explained. "This will allow us to put into play these key learnings at the front-end of an IT downtime disaster, rather than learning about our inefficiencies and deficiencies, and building our solutions, on the fly."Exhilarating agilityA big lesson for Lindsay-Wood of Moffitt Cancer Center centered on agility."There is nothing like a good disaster to bring people together in a different way," she said.

"It was exhilarating to see teams that don't usually spend time together creating solutions to address an urgent need. One specific area for us was virtual visits, which we had in place prior to the stay at home order."We recognized immediately that to scale dramatically to ensure we can keep treating our patients we had to do something dramatically different as our current telemedicine platform could not scale rapidly for a number of reasons," she continued. "The great ideas come from amazing places in the organization and sometimes leadership needs to get out of the way."Beth Lindsay-Wood, Moffitt Cancer Center"We increased visits by 5,000% in two weeks.

In order to do that, we used a well-known communications platform as a base. It was easy to use for patients and providers with minimal training, had robust architecture, and is secure and already used in our organization."In addition to preparing the platform and users, staff rapidly developed software to integrate both their EHR and patient portal for scheduling, notifications and other key requirements."A multidisciplinary team worked on all aspects of rolling all this out extremely fast. It was amazing to watch," she said.

"Great ideas were fostered, everyone engaged to see what they could do to help. All areas of IT were in the mix, platform support and new development leveraging an agile framework for rolling out changes, running virtual command centers, provider and patient training, at the elbow support, some of it virtual as well."We knew it was critical to get this online within the first few weeks to ensure our cancer patients had no delays in care," she continued. "We used a huddle format twice a day in IT that included all areas to foster ideas, garner support and maintain focus.

There were many examples of this during asthma treatment, but this stands out as an early example of how much we can accomplish in a short period of time if everyone is working together with focus."Lindsay-Wood and her team are leveraging a model called radical interdependence (RI) to ensure they engage and empower teams to work together."The great ideas come from amazing places in the organization, and sometimes leadership needs to get out of the way. And the best thing we can do is let teams work together 'without walls' or differing priorities, and allow failure of ideas," she said. "My vision of without walls is having a big open space with mobile desks that allow people to join teams to solve specific problems."But not just new and innovative initiatives, all work," she added.

"This is a mantra for our new Center for Digital Health, a new organization that includes IT, health data services and digital innovation. The idea is that radical interdependence doesn't have any heroes. It is all of us that bring their specific skills to the table to evaluate ideas and solve problems, and get egos out of it."She sees the matrix structure as more important than the formalized reporting structures, ensuring they do not duplicate skills across organizations, reducing siloes and relying heavily on one another in different ways to achieve the most important work staff can do to prevent and cure cancer."It really is about the mission and transforming the organization," she said.Speedy teamworkAnother health IT lesson Sky Lakes learned in the past year, spurred by the unusual setting and requirements of 2020, has to do with never-used-before technologies that were brought online through "the resiliency, creativity, thoughtfulness, compassion and ingenuity of our IT teams partnering in close coordination with clinical, financial and operational teams in a moment's notice," said Gaede of Sky Lakes Medical Center."A prime example, experienced by many in our industry in the past year, was acknowledging that our telehealth capabilities were not robust enough," he recalled.

"In response, we built out full-scale telemedicine technologies and workflows literally over a weekend. Our teams discussed rolling out telehealth on a Thursday morning, looked at various technologies that Thursday afternoon, discussed the technologies with clinical, financial and operational leaders late Thursday afternoon, engaged a vendor the next day, and went live on Monday morning."This kind of innovation is typically a nine-month project, coordinating all the people, processes and technologies," he added. "Not so in 2020, when it was a weekend process."Gaede and his team will be applying this lesson by starting with an understanding that crises can breed ingenuity."The idea here is to no longer wait for the crises to think outside the box, but rather to dream it, create it and implement it now," he said.

"We had to have our infrastructure in place and be able to scale rapidly. Setting up overnight drive-through clinics, overnight call centers and the like all demanded a robust investment in IT and technologies that allow scale."Fortunately, he added, Sky Lakes Medical Center supported investments in key technologies in the years prior that allowed this scale."You never know the curve ball life will throw, and having the right technologies and vendor partnerships in place are literal lifesavers," he said.Hiring under difficult circumstancesOn another front, Lindsay-Wood of Moffitt Cancer Center was the interim CIO when asthma treatment arrived. In January 2020, she had just received approval for funding to dramatically increase staffing in IT in order to rapidly mature the IT group and address gaps in services and tools."I mean adding 50% of our current workforce into the organization," she stressed.

"Moffitt was growing very rapidly, and we needed to grow and mature rapidly to support our strategic plan along with a very complex environment with a strong research mission and our highly specialized patient care environment due to our specialized oncology services."It was very difficult to hire during asthma treatment and required a tremendous amount of perseverance by our leaders in IT and our HR team to move that along," she continued. "We have onboarded well over 100 people during the year of asthma treatment, most of which was all virtual from recruitment through orientation."Much of IT was virtual until early April of this year, which was the first time leaders saw many of their team members."It was great meeting people in person, working in our new expanded building space, creating our new culture – all driven by our maturity efforts," Lindsay-Wood said. "We keep to huddles and rounds to ensure constant communication on our efforts to improve our core processes, implement our new IT tools, increase team member education and development, and learn to run IT as a business."All of that work was happening while we addressed asthma treatment-related projects, several strategic and operational initiatives (opening a new ambulatory center, building a new hospital, etc.) very successfully," she continued.

"It has been a challenge and a delight to see the progress we are making on a number of fronts, forging partnerships within the organization, and constantly improving our core metrics – keeping our eye on the ball."While the staff was working hard on the maturity efforts, the organization just kept moving and the staff stayed engaged, which was so important to advancing the mission, she added.Getting things done"The lesson is that you don't let something like a ventolin become the focus and make that a reason not to get important things done," she said. "It could have happened easily – putting our fortification efforts on hold, halting recruitment efforts, slowing down strategic initiatives, cancelling important projects."We really didn't do that for the most part," she continued. "The organization was really smart, and implemented cost savings initiatives extremely early, which put us in a more favorable position.

I think we all hoped that the ventolin would be short and merciful, but our leaders planned for a long haul and took early steps to manage it."No one came out unscathed in this. Everyone had a tremendous challenge to keep moving forward, she said."Our research had to continue. Our clinical trials are critical to our patient outcomes, and our patient complexity required us to operate as close to normal as possible," she concluded.

"There was no playbook for much of this, but we – all of healthcare – have one now."Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.The rapid push to digitalization and consumerization in healthcare means providing a seamless experience for patients across in-person, phone and online contacts.The financial and commercial sectors figured out long ago how to manage huge volumes of confidential customer data and provide a seamless experience across phone, online and in-person contacts.Christen Castellano, vice president of customer experience channels at Banner Health, is tasked with making it easier to receive care for their hundreds of thousands of patients.

She is scheduled to speak about her work at HIMSS21.Castellano is leading the development and rollout of a digital health transformation initiative to deliver a modern, enterprise-wide platform to patients and physicians through a digital front door."The intention improves access to care and improves convenience for customers and for team members," she said. "By making it easy to find a doctor and schedule online, we’ve substantially improved both."She noted research firm Gartner ranked Banner Health seventh in ease of use and the health system has seen a 92% increase in appointments booked online over the last year."The increase in self-service appointment scheduling also allows more capacity for populations, such as seniors and the underserved, to access person-assisted appointments by phone, so the lift is across both channels," she said.Because all health systems have electronic health records that hold hundreds of information fields for each patient, the most important decision to be made is how much of the EHR data is "just enough" to deliver personalized communications without compromising privacy.At Banner, each patient has more than 1,000 fields in their EHR, she said, but they only feed 14 of those into their customer database and then enrich it with geo demographics and transaction data.She noted the biggest interoperability challenge typically relates to the company’s middleware and how it subscribes and publishes data to its legacy systems and other applications."Our approach is similar to the financial industry, which also has confidential and highly regulated data," said Castellano. "Customers expect and deserve a frictionless experience in all industries, including healthcare, so we’re creating digital environments to meet people where they are."She said the aim is to serve multiple stakeholders across multiple channels.

As a result, the transformation has shaped both Banner’s organic and inorganic growth strategies."It is also foundational to retention and engagement for both customers and staff, which are critical to successfully executing our growth plans," she said. "A robust enterprise-wide digital platform brings convenience and connection at scale for patients and team members."Christen Castellano will share some digital front door best practices during her HIMSS21 session, "Creating a Seamless Customer Healthcare Experience Through Digital Transformation." It's scheduled for Tuesday, August 10, from 4:15 p.m.-5:15 p.m., in room Murano 3201A. Nathan Eddy is a healthcare and technology freelancer based in Berlin.Email the writer.

Nathaneddy@gmail.comTwitter. @dropdeaded209HotDoc, a Melbourne-based patient engagement platform provider, has partnered with two major hospitals in Australia for vaccination booking projects.WHY IT MATTERSThis week, Austin Hospital in Melbourne started using HotDoc's complete scheduling solution and tools for eligibility screening and stock management for asthma treatment inoculations. The hospital aims to schedule approximately 1,000 asthma treatment vaccination appointments each day.HotDoc said its platform will also be deployed at St.

Vincent's Hospital in Sydney for booking administration of influenza vaccination for staff, featuring walk-ins, appointment calendars and online consent forms. It will also enable the hospital to conduct online patient verification check enhancements through Medicare Check and the submission of immunisation records through its Australian Immunisation Register-integrated platform.HotDoc estimates that its platform has enabled 2.5 million appointments for asthma treatment vaccinations to date.THE LARGER TRENDTechnology providers rose to the occasion to support vaccination initiatives across the world. Notable players in this space include Zocdoc and Microsoft.

Luma Health in January introduced its range of solutions to enable rapid treatment delivery and operation, including a scheduling tool.In the UK, medtech startup DrDoctor helps streamline the vaccination of over 1 million NHS workers through its QuickBook solution.Bahrain was reportedly the first country to allow asthma treatment vaccination appointments via a mobile app. Since January, citizens of the country have been able to schedule their free immunisations through the BeAware app.ON THE RECORD"Working with hospitals to ensure their staff are vaccinated is a real thrill for HotDoc and aligns further with our mission to improve the healthcare experience for everyone in Australia. We look forward to long partnerships with these hospitals into the future," HotDoc CEO Ben Hurst said in a statement..

Buy ventolin no prescription

By Robert how to buy cheap ventolin Preidt buy ventolin no prescription HealthDay Reporter FRIDAY, Sept. 11, 2020 (HealthDay News) -- There may have been cases of asthma treatment in Los Angeles as early as last December, months before the first known U.S. Cases were identified, a new buy ventolin no prescription study claims. Researchers analyzed data from more than 10 million patient visit records for University of California, Los Angeles (UCLA) Health outpatient, emergency department and hospital facilities.

They compared data from the period between Dec. 1, 2019, and buy ventolin no prescription Feb. 29, 2020, to data from the same months in the previous five years. Outpatient visits for coughs increased 50% in the months before the ventolin, and exceeded the average buy ventolin no prescription number of visits for the same symptoms by more than 1,000 compared with the same time period in the previous five years.

The researchers also found that in the months before the ventolin, there was a significant increase in the number of patients with coughs seen at emergency departments, and in the number of patients hospitalized with acute respiratory failure. The study was published Sept. 10 in the Journal of Medical Internet Research buy ventolin no prescription. Other factors -- such as the flu and vaping -- could have contributed to some of the unexpected increase, but the findings show the importance of analyzing electronic health records to quickly identify unusual changes in patient patterns, according to the researchers.

"For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come," said study lead author Dr. Joann Elmore, a professor of medicine at UCLA's David buy ventolin no prescription Geffen School of Medicine. "The majority of asthma treatment studies evaluate hospitalization data, but we also looked at the larger outpatient clinic setting, where most patients turn first for medical care when illness and symptoms arise," she said in an UCLA news release. "We may never truly know if these excess patients buy ventolin no prescription represented early and undetected asthma treatment cases in our area," Elmore said.

"But the lessons learned from this ventolin, paired with health care analytics that enable real-time surveillance of disease and symptoms, can potentially help us identify and track emerging outbreaks and future epidemics." WebMD News from HealthDay Sources SOURCE. University of California, Los Angeles, news release, Sept. 10, 2020 Copyright buy ventolin no prescription © 2013-2020 HealthDay. All rights reserved.Overall, having a history of high blood pressure increased a person's risk of kidney injury about fivefold, the Italian study found.

A third study digging deeper into this phenomenon found that common blood pressure meds were associated with an increased risk of death among asthma treatment patients. The researchers tracked 172 people buy ventolin no prescription hospitalized for asthma treatment at the University of Miami/JFK Medical Center in Atlantis, Fla. The investigators found that 33% of people taking either angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) died in the hospital, compared with 13% of people not taking either drug. asthma treatment patients were also more likely to land in the intensive care unit if they were taking one of these blood pressure meds -- 28% of those with a prescription versus buy ventolin no prescription 13% not taking either drug.

Dr. Vivek Bhalla, director of the Stanford Hypertension Center in California, said it's not very likely that these blood pressure medications in themselves are harmful to asthma treatment patients. Instead, "the medicines are markers of the underlying disease for which they were buy ventolin no prescription prescribed," Bhalla said. "For example, patients with [high blood pressure] or diabetes have worse outcomes with asthma treatment, and these are the same patients that are commonly prescribed ACE inhibitors and ARBs," Bhalla said.

"Other blood pressure medications may be associated with severity of asthma treatment if one considers that low blood pressure, perhaps buy ventolin no prescription due to use of these medications, may be associated with higher mortality." If they contract asthma treatment, people with high blood pressure should talk with their doctor for guidance on taking their medication, Bhalla said. "In general, current data suggest that the medications themselves are not harmful, and the consequences of stopping these medications are well-documented," Bhalla said. "However, if folks feel that they are not eating as much as they normally do, or have symptoms that lead to dehydration, such as vomiting, diarrhea, bleeding, or excessive sweating, then it is very reasonable to temporarily hold their higher blood pressure medication until their symptoms resolve." Doctors should assess asthma treatment patients and not keep them on blood pressure meds if their blood pressure drops or they have other troubling symptoms, Bhalla said."Having a five- to 10-minute chat or phone conversation in the moment when something is stressful can be just as valuable as spending an hour a month in therapy," Singer said. In the new report, the researchers found that the suicide rate for adolescents and buy ventolin no prescription young adults more than doubled in New Hampshire between 2007 and 2018.

Elsewhere, rate increases included 22% in Maryland. 41% in Illinois. 51% in Colorado, buy ventolin no prescription and 79% in Oregon. In 2016-2018, suicide rates among young people were highest in Alaska, while some of the cheap ventolin online lowest rates were in the Northeast.

Yet even New Jersey, which had the lowest rate in that three-year period, saw a 39% increase, Curtin pointed buy ventolin no prescription out. Dr. Emmy Betz, an associate professor of emergency medicine at the University of Colorado School of Medicine, thinks the reasons for the increases in young people's suicides are complicated and not clearly understood. "The first thing is just to look out for each other, for our kids, for our communities and ask if we're worried about someone buy ventolin no prescription and say something," she said.

"It can feel awkward, but people are grateful, usually." Use available resources, added Betz, who is also a spokesperson for the American College of Emergency Physicians. She was not involved with the study. "The crisis hotline is free and available, and there's online chat, so there are ways to reach out and get help even if you feel like you don't want to talk to someone in your life about what you're buy ventolin no prescription going through," Betz said. "Or if you're worried about someone and you don't know what to do, you can always call those resources as well." If someone is having an immediate crisis, call 911 for help, she added.

Betz noted that parents should keep the tools of suicide, such as guns and drugs, locked so buy ventolin no prescription that young people can't get to them. Singer added that what this new report doesn't reflect is a very large increase in suicidal thoughts among youth this year, largely due to the asthma ventolin and a souring economy. "But it is also important to know that there's not a direct relationship between an increase in suicidal thoughts and a corresponding increase in suicide deaths," he said. WebMD News from HealthDay Sources buy ventolin no prescription SOURCES.

Sally Curtin, M.A., National Center for Health Statistics, U.S. Centers for buy ventolin no prescription Disease Control and Prevention. Jonathan Singer, Ph.D., L.C.S.W., associate professor, School of Social Work, Loyola University Chicago, and president, American Association of Suicidology. Emmy Betz, M.D., spokesperson, American College of Emergency Physicians, associate professor, emergency medicine, University of Colorado School of Medicine, Denver.

CDC report:State Suicide Rates Among Adolescents and Young buy ventolin no prescription Adults Aged 10-24. United States, 2000-2018, Sept. 11, 2020 Copyright © 2013-2020 HealthDay. All rights reserved.FRIDAY, Sept buy ventolin no prescription.

11, 2020 (HealthDay News) -- Cat lovers, be aware. New research suggests that asthma treatment may be more common in cats than buy ventolin no prescription previously thought. Scientists analyzed blood samples taken from 102 cats between January and March 2020 in Wuhan, China, after the world's first known outbreak of asthma treatment began in that city. Fifteen of the cats had asthma treatment antibodies in their blood, and 11 of those cats had neutralizing antibodies that bind to the asthma and block .

None of the cats tested positive for buy ventolin no prescription asthma treatment or had obvious symptoms, and none of them died during follow-up, according to the study published online Sept. 1 in the journal Emerging Microbes &. s. The cats in the study included 46 from three animal shelters, 41 from buy ventolin no prescription five pet hospitals, and 15 from families with asthma treatment patients.

The highest levels of antibodies were seen in three cats owned by patients who'd been diagnosed with asthma treatment, but there were also signs of cats being infected with the ventolin by other cats from shelters or from pet hospitals. While there is currently no evidence of transmission of the buy ventolin no prescription new asthma between humans and cats, people should consider taking precautions, said study author Meilin Jin, from Huazhong Agricultural University, in Wuhan. "Although the in stray cats could not be fully understood, it is reasonable to speculate that these s are probably due to the contact with asthma polluted environment, or asthma treatment patients who fed the cats," Jin said in a journal news release. "Therefore, measures should be considered to maintain a suitable distance between asthma treatment patients and companion animals such as cats and dogs, and hygiene and quarantine measures should also be established for those high-risk animals," Jin noted.

One of the findings was that buy ventolin no prescription the antibodies response in cats infected with the new asthma was similar to that seen in response to seasonal asthma s, which suggests that cats who've been infected with the new asthma "remain at risk of re-," according to the researchers. This antibody response is similar to what's seen in humans. "We suggest that cats have a great potential as an animal model for assessing the characteristic of antibody against asthma in humans," the study authors concluded..

By Robert Preidt HealthDay continue reading this Reporter FRIDAY, can i get ventolin over the counter uk Sept. 11, 2020 (HealthDay News) -- There may have been cases of asthma treatment in Los Angeles as early as last December, months before the first known U.S. Cases were identified, a new can i get ventolin over the counter uk study claims. Researchers analyzed data from more than 10 million patient visit records for University of California, Los Angeles (UCLA) Health outpatient, emergency department and hospital facilities. They compared data from the period between Dec.

1, 2019, can i get ventolin over the counter uk and Feb. 29, 2020, to data from the same months in the previous five years. Outpatient visits for coughs increased 50% in the months before the ventolin, and exceeded the average number of visits for the same symptoms by more than 1,000 compared with the same time period can i get ventolin over the counter uk in the previous five years. The researchers also found that in the months before the ventolin, there was a significant increase in the number of patients with coughs seen at emergency departments, and in the number of patients hospitalized with acute respiratory failure. The study was published Sept.

10 in the Journal can i get ventolin over the counter uk of Medical Internet Research. Other factors -- such as the flu and vaping -- could have contributed to some of the unexpected increase, but the findings show the importance of analyzing electronic health records to quickly identify unusual changes in patient patterns, according to the researchers. "For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come," said study lead author Dr. Joann Elmore, a professor of medicine at UCLA's David Geffen can i get ventolin over the counter uk School of Medicine. "The majority of asthma treatment studies evaluate hospitalization data, but we also looked at the larger outpatient clinic setting, where most patients turn first for medical care when illness and symptoms arise," she said in an UCLA news release.

"We may never truly know if these excess patients can i get ventolin over the counter uk represented early and undetected asthma treatment cases in our area," Elmore said. "But the lessons learned from this ventolin, paired with health care analytics that enable real-time surveillance of disease and symptoms, can potentially help us identify and track emerging outbreaks and future epidemics." WebMD News from HealthDay Sources SOURCE. University of California, Los Angeles, news release, Sept. 10, 2020 can i get ventolin over the counter uk Copyright © 2013-2020 HealthDay. All rights reserved.Overall, having a history of high blood pressure increased a person's risk of kidney injury about fivefold, the Italian study found.

A third study digging deeper into this phenomenon found that common blood pressure meds were associated with an increased risk of death among asthma treatment patients. The researchers tracked 172 people hospitalized for asthma treatment at the University can i get ventolin over the counter uk of Miami/JFK Medical Center in Atlantis, Fla. The investigators found that 33% of people taking either angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) died in the hospital, compared with 13% of people not taking either drug. asthma treatment patients were also more likely to land in the intensive care unit if they were taking one of these blood pressure meds -- 28% of those can i get ventolin over the counter uk with a prescription versus 13% not taking either drug. Dr.

Vivek Bhalla, director of the Stanford Hypertension Center in California, said it's not very likely that these blood pressure medications in themselves are harmful to asthma treatment patients. Instead, "the medicines are markers of the can i get ventolin over the counter uk underlying disease for which they were prescribed," Bhalla said. "For example, patients with [high blood pressure] or diabetes have worse outcomes with asthma treatment, and these are the same patients that are commonly prescribed ACE inhibitors and ARBs," Bhalla said. "Other blood pressure medications may be associated with severity of asthma treatment if one can i get ventolin over the counter uk considers that low blood pressure, perhaps due to use of these medications, may be associated with higher mortality." If they contract asthma treatment, people with high blood pressure should talk with their doctor for guidance on taking their medication, Bhalla said. "In general, current data suggest that the medications themselves are not harmful, and the consequences of stopping these medications are well-documented," Bhalla said.

"However, if folks feel that they are not eating as much as they normally do, or have symptoms that lead to dehydration, such as vomiting, diarrhea, bleeding, or excessive sweating, then it is very reasonable to temporarily hold their higher blood pressure medication until their symptoms resolve." Doctors should assess asthma treatment patients and not keep them on blood pressure meds if their blood pressure drops or they have other troubling symptoms, Bhalla said."Having a five- to 10-minute chat or phone conversation in the moment when something is stressful can be just as valuable as spending an hour a month in therapy," Singer said. In the new report, the researchers found that the suicide rate can i get ventolin over the counter uk for adolescents and young adults more than doubled in New Hampshire between 2007 and 2018. Elsewhere, rate increases included 22% in Maryland. 41% in Illinois. 51% in Colorado, and 79% can i get ventolin over the counter uk in Oregon.

In 2016-2018, suicide rates among young people article were highest in Alaska, while some of the lowest rates were in the Northeast. Yet even can i get ventolin over the counter uk New Jersey, which had the lowest rate in that three-year period, saw a 39% increase, Curtin pointed out. Dr. Emmy Betz, an associate professor of emergency medicine at the University of Colorado School of Medicine, thinks the reasons for the increases in young people's suicides are complicated and not clearly understood. "The first thing is just can i get ventolin over the counter uk to look out for each other, for our kids, for our communities and ask if we're worried about someone and say something," she said.

"It can feel awkward, but people are grateful, usually." Use available resources, added Betz, who is also a spokesperson for the American College of Emergency Physicians. She was not involved with the study. "The crisis hotline is free and available, and there's online chat, so there are ways to reach out and get help even if you feel like you don't want to talk to someone in your life can i get ventolin over the counter uk about what you're going through," Betz said. "Or if you're worried about someone and you don't know what to do, you can always call those resources as well." If someone is having an immediate crisis, call 911 for help, she added. Betz noted that parents should keep the tools of suicide, such as guns and drugs, locked so that can i get ventolin over the counter uk young people can't get to them.

Singer added that what this new report doesn't reflect is a very large increase in suicidal thoughts among youth this year, largely due to the asthma ventolin and a souring economy. "But it is also important to know that there's not a direct relationship between an increase in suicidal thoughts and a corresponding increase in suicide deaths," he said. WebMD News from HealthDay Sources SOURCES can i get ventolin over the counter uk. Sally Curtin, M.A., National Center for Health Statistics, U.S. Centers for Disease Control can i get ventolin over the counter uk and Prevention.

Jonathan Singer, Ph.D., L.C.S.W., associate professor, School of Social Work, Loyola University Chicago, and president, American Association of Suicidology. Emmy Betz, M.D., spokesperson, American College of Emergency Physicians, associate professor, emergency medicine, University of Colorado School of Medicine, Denver. CDC report:State Suicide Rates Among Adolescents and Young Adults Aged 10-24 can i get ventolin over the counter uk. United States, 2000-2018, Sept. 11, 2020 Copyright © 2013-2020 HealthDay.

All rights reserved.FRIDAY, can i get ventolin over the counter uk Sept. 11, 2020 (HealthDay News) -- Cat lovers, be aware. New research suggests that asthma treatment may be more common in cats than previously can i get ventolin over the counter uk thought. Scientists analyzed blood samples taken from 102 cats between January and March 2020 in Wuhan, China, after the world's first known outbreak of asthma treatment began in that city. Fifteen of the cats had asthma treatment antibodies in their blood, and 11 of those cats had neutralizing antibodies that bind to the asthma and block .

None of the cats tested positive for asthma treatment or had obvious symptoms, and none of them can i get ventolin over the counter uk died during follow-up, according to the study published online Sept. 1 in the journal Emerging Microbes &. s. The cats in the study included 46 from three animal shelters, 41 from five pet hospitals, and 15 from families with asthma treatment patients. The highest levels of antibodies were seen in three cats owned by patients who'd been diagnosed with asthma treatment, but there were also signs of cats being infected with the ventolin by other cats from shelters or from pet hospitals.

While there is currently no evidence of transmission of the new asthma between humans and cats, people should consider taking precautions, said study author Meilin Jin, from Huazhong Agricultural University, in Wuhan. "Although the in stray cats could not be fully understood, it is reasonable to speculate that these s are probably due to the contact with asthma polluted environment, or asthma treatment patients who fed the cats," Jin said in a journal news release. "Therefore, measures should be considered to maintain a suitable distance between asthma treatment patients and companion animals such as cats and dogs, and hygiene and quarantine measures should also be established for those high-risk animals," Jin noted. One of the findings was that the antibodies response in cats infected with the new asthma was similar to that seen in response to seasonal asthma s, which suggests that cats who've been infected with the new asthma "remain at risk of re-," according to the researchers. This antibody response is similar to what's seen in humans.

"We suggest that cats have a great potential as an animal model for assessing the characteristic of antibody against asthma in humans," the study authors concluded..

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Familial hypercholesterolaemia (FH) is the order ventolin online most common autosomal dominant genetic condition, affecting about 1 in 250 people, caused by a pathogenic variant in one of several genes involved in lipoprotein cholesterol catabolism. Treatment of elevated serum low-density lipoprotein cholesterol in people with FH substantially reduces the risk of ischaemic heart disease and cardiovascular mortality. Yet, the vast majority of FH cases are undiagnosed and, thus, untreated. Diagnosis is challenging because patients typically are asymptomatic, may not know their family history, are unaware of the seriousness of the diagnosis and may not even be seeing a physician regularly order ventolin online. In addition, the phenotypic diagnosis requires more than just serum cholesterol levels.In this issue of Heart, Carvalho and colleagues1 demonstrated the feasibility of the FH Case Ascertainment Tool (FAMCAT) for identifying patients likely to have FH in a cohort of 777 128 primary care patients in London.

The FAMCAT score is based on systematic screening of routine primary care records for cholesterol measurements, age, triglycerides, family history, diabetes, kidney disease and current use of lipid-lowering drugs (figure 1). The use of FAMCAT to identify patients likely to have FH could ensure more accurate and rapid diagnosis (and subsequent treatment) for this group of patients at high risk of cardiovascular disease.Risk of familial hypercholesterolaemia (FH) in inner East London calculated using FAMCAT algorithm, assuming population prevalence of order ventolin online 1 in 500 and 1 in 250. IHD, ischaemic heart disease. PP, population prevalence." data-icon-position data-hide-link-title="0">Figure 1 Risk of familial hypercholesterolaemia (FH) in inner East London calculated using FAMCAT algorithm, assuming population prevalence of 1 in 500 and 1 in 250. IHD, ischaemic order ventolin online heart disease.

PP, population prevalence.A different approach to detection of FH was used by Brett and colleagues2 in a cohort of 232, 139 Australian general practice patients. Using a pragmatic two-step approach, they first identified those at higher risk of FH using the TARB-Ex electronic screening tool. Then, in the 1843 (0.8%) of patients order ventolin online identified electronically by TARB-Ex, clinical assessment by the physician was used to confirm a high FH risk the based on the phenotypic Dutch Lipid Clinic Network Criteria score. In a subset of 77 patients with FH, subsequent intensification of lipid-lowering therapy led to a further reduction in serum cholesterol levels .In an editorial, Qureshi and Patel3 summarise methods using the electronic health record (EHR) for improved diagnosis of FH (figure 2) and point out that the EHR approach often is limited by inadequate or missing data about family history, physical signs and other information. Cholesterol levels, while not diagnostic in isolation, are essential for the diagnosis but may not have been measured in many asymptomatic individuals.

They conclude order ventolin online. €˜Ultimately, successfully identifying the thousands of people with FH in the UK and abroad will require a system-wide approach from opportunistic identification at routine health encounters, systematic case finding in primary care, screening people at the time of a premature CVD event to child–parent screening and cascade testing.’Pathway to identification of FH from primary care. CVD, cardiovascular disease. DLCN, Dutch order ventolin online Lipid Clinic Network. FAMCAT, FH Case Ascertainment Tool.

FH, familial hypercholesterolaemia. GP, general order ventolin online practitioner. HCA, healthcare assistant. LLT, lipid-lowering treatment. VUS, variant of unknown significance." data-icon-position data-hide-link-title="0">Figure 2 order ventolin online Pathway to identification of FH from primary care.

CVD, cardiovascular disease. DLCN, Dutch Lipid Clinic Network. FAMCAT, FH order ventolin online Case Ascertainment Tool. FH, familial hypercholesterolaemia. GP, general practitioner.

HCA, healthcare assistant order ventolin online. LLT, lipid-lowering treatment. VUS, variant of unknown significance.Also, in this issue of Heart, Schwerzmann and colleague4 report clinical outcomes in 105 patients adult congenital heart disease (ACHD) with asthma treatment s. Overall, 5 patients died and 13 had a complication disease course order ventolin online. Clinical features associated with a complicated disease course were similar to the general population including older age, the presence of two or more comorbidities, and obesity (figure 3).

In addition, those with a complicated disease course were more likely to have cyanotic heart disease such as unrepaired cyanotic defects are Eisenmenger syndrome, compared with ACHD patients with an uncomplicated asthma treatment course (OR 60, 95% CI 7.6 to 474).Univariable significant asthma treatment risk factors in patients with adult congenital heart disease and the corresponding ORs. We propose to stratify patients based on age, number of comorbidities, weight and presence of a high-risk cardiac lesion (cyanotic heart disease) order ventolin online. BMI, body mass index." data-icon-position data-hide-link-title="0">Figure 3 Univariable significant asthma treatment risk factors in patients with adult congenital heart disease and the corresponding ORs. We propose to stratify patients based on age, number of comorbidities, weight and presence of a high-risk cardiac lesion (cyanotic heart disease). BMI, body order ventolin online mass index.Yuan and Oechslin comment in an editorial5 that ‘Contrary to our previous conceptualisation of risk, anatomical complexity does not appear to predict severe or death.

Rather, patient-specific risk factors similar to those in the non-CHD cohort remain important, while strong CHD-specific risk factors for severe illness or death after asthma treatment were cyanotic heart disease and physiological stage. These results help us to tailor patient recommendations but require further confirmation in large international, multicentre studies that are sufficiently powered to answer our remaining questions.’A meta-analysis by Imazio and colleagues6 supports the efficacy of anti-interleukin-1 agents, such as anakinra and rilonacept, for prevention of recurrent episodes of pericarditis in patients with corticosteroid-dependent and colchicine-resistant recurrent pericarditis. Anthony and Collier7 remind us that recurrent pericarditis complicates 15%–30% of order ventolin online index cases of pericarditis. The clinical consequences, in addition to pain, can be serious including recurrent effusions, tamponade physiology and constrictive pericarditis. And there is little data on effective therapies (figure 4).8 They conclude ‘Inhibition of the IL-1 pathway may represent a paradigm shift in the treatment of patients with recurrent pericarditis despite standard therapy.

However, larger RCT data are required for further validation of the efficacy and safety of these novel medications in order ventolin online the treatment of recurrent pericarditis.’Interleukin-1 alpha and beta in pericardial inflammation. Adapted from Klein et al. 8 " data-icon-position data-hide-link-title="0">Figure 4 Interleukin-1 alpha and beta in pericardial inflammation. Adapted from Klein et al.8The order ventolin online Education in Heart article in this issue provides a quick overview of cardio-oncology for the general cardiologist. Cardio-oncology is defined as ‘the treatment and prevention of cardiovascular disease in cancer patients both during oncology treatment and afterwards.’9A basic understanding of cardio-oncology now is considered core knowledge for every cardiologist, given the demographic overlap in the prevalence of cardiovascular disease and cancer, in addition to the potential cardiotoxic effects of cancer treatments.

The information and practical advice in this review article are a concise resource for busy practitioners.Our short Cardiology in Focus article10 provides a brief overview of cost-effectiveness methodology, with a short list of references for those who wish to dive deeper into this topic.Ethics statementsPatient consent for publicationNot required..

Familial hypercholesterolaemia can i get ventolin over the counter uk (FH) is the most common autosomal dominant genetic condition, affecting about 1 in 250 people, caused by a pathogenic variant in one of several genes involved in lipoprotein cholesterol catabolism. Treatment of elevated serum low-density lipoprotein cholesterol in people with FH substantially reduces the risk of ischaemic heart disease and cardiovascular mortality. Yet, the vast majority of FH cases are undiagnosed and, thus, untreated.

Diagnosis is challenging because patients typically are can i get ventolin over the counter uk asymptomatic, may not know their family history, are unaware of the seriousness of the diagnosis and may not even be seeing a physician regularly. In addition, the phenotypic diagnosis requires more than just serum cholesterol levels.In this issue of Heart, Carvalho and colleagues1 demonstrated the feasibility of the FH Case Ascertainment Tool (FAMCAT) for identifying patients likely to have FH in a cohort of 777 128 primary care patients in London. The FAMCAT score is based on systematic screening of routine primary care records for cholesterol measurements, age, triglycerides, family history, diabetes, kidney disease and current use of lipid-lowering drugs (figure 1).

The use of FAMCAT to identify patients likely to have FH could ensure more accurate and rapid diagnosis (and subsequent treatment) for this group of patients at high risk of cardiovascular disease.Risk of familial hypercholesterolaemia (FH) in inner East London calculated using FAMCAT algorithm, assuming population prevalence of 1 in can i get ventolin over the counter uk 500 and 1 in 250. IHD, ischaemic heart disease. PP, population prevalence." data-icon-position data-hide-link-title="0">Figure 1 Risk of familial hypercholesterolaemia (FH) in inner East London calculated using FAMCAT algorithm, assuming population prevalence of 1 in 500 and 1 in 250.

IHD, ischaemic heart can i get ventolin over the counter uk disease. PP, population prevalence.A different approach to detection of FH was used by Brett and colleagues2 in a cohort of 232, 139 Australian general practice patients. Using a pragmatic two-step approach, they first identified those at higher risk of FH using the TARB-Ex electronic screening tool.

Then, in the 1843 (0.8%) of patients identified electronically by TARB-Ex, clinical can i get ventolin over the counter uk assessment by the physician was used to confirm a high FH risk the based on the phenotypic Dutch Lipid Clinic Network Criteria score. In a subset of 77 patients with FH, subsequent intensification of lipid-lowering therapy led to a further reduction in serum cholesterol levels .In an editorial, Qureshi and Patel3 summarise methods using the electronic health record (EHR) for improved diagnosis of FH (figure 2) and point out that the EHR approach often is limited by inadequate or missing data about family history, physical signs and other information. Cholesterol levels, while not diagnostic in isolation, are essential for the diagnosis but may not have been measured in many asymptomatic individuals.

They conclude can i get ventolin over the counter uk. €˜Ultimately, successfully identifying the thousands of people with FH in the UK and abroad will require a system-wide approach from opportunistic identification at routine health encounters, systematic case finding in primary care, screening people at the time of a premature CVD event to child–parent screening and cascade testing.’Pathway to identification of FH from primary care. CVD, cardiovascular disease.

DLCN, Dutch can i get ventolin over the counter uk Lipid Clinic Network. FAMCAT, FH Case Ascertainment Tool. FH, familial hypercholesterolaemia.

GP, general practitioner can i get ventolin over the counter uk. HCA, healthcare assistant. LLT, lipid-lowering treatment.

VUS, variant of unknown significance." data-icon-position can i get ventolin over the counter uk data-hide-link-title="0">Figure 2 Pathway to identification of FH from primary care. CVD, cardiovascular disease. DLCN, Dutch Lipid Clinic Network.

FAMCAT, FH can i get ventolin over the counter uk Case Ascertainment Tool. FH, familial hypercholesterolaemia. GP, general practitioner.

HCA, healthcare can i get ventolin over the counter uk assistant. LLT, lipid-lowering treatment. VUS, variant of unknown significance.Also, in this issue of Heart, Schwerzmann and colleague4 report clinical outcomes in 105 patients adult congenital heart disease (ACHD) with asthma treatment s.

Overall, 5 patients died and 13 had a complication disease course can i get ventolin over the counter uk. Clinical features associated with a complicated disease course were similar to the general population including older age, the presence of two or more comorbidities, and obesity (figure 3). In addition, those with a complicated disease course were more likely to have cyanotic heart disease such as unrepaired cyanotic defects are Eisenmenger syndrome, compared with ACHD patients with an uncomplicated asthma treatment course (OR 60, 95% CI 7.6 to 474).Univariable significant asthma treatment risk factors in patients with adult congenital heart disease and the corresponding ORs.

We propose to stratify patients based on age, number of comorbidities, weight and presence of a can i get ventolin over the counter uk high-risk cardiac lesion (cyanotic heart disease). BMI, body mass index." data-icon-position data-hide-link-title="0">Figure 3 Univariable significant asthma treatment risk factors in patients with adult congenital heart disease and the corresponding ORs. We propose to stratify patients based on age, number of comorbidities, weight and presence of a high-risk cardiac lesion (cyanotic heart disease).

BMI, body mass index.Yuan and Oechslin can i get ventolin over the counter uk comment in an editorial5 that ‘Contrary to our previous conceptualisation of risk, anatomical complexity does not appear to predict severe or death. Rather, patient-specific risk factors similar to those in the non-CHD cohort remain important, while strong CHD-specific risk factors for severe illness or death after asthma treatment were cyanotic heart disease and physiological stage. These results help us to tailor patient recommendations but require further confirmation in large international, multicentre studies that are sufficiently powered to answer our remaining questions.’A meta-analysis by Imazio and colleagues6 supports the efficacy of anti-interleukin-1 agents, such as anakinra and rilonacept, for prevention of recurrent episodes of pericarditis in patients with corticosteroid-dependent and colchicine-resistant recurrent pericarditis.

Anthony and Collier7 remind us that recurrent pericarditis complicates 15%–30% of index can i get ventolin over the counter uk cases of pericarditis. The clinical consequences, in addition to pain, can be serious including recurrent effusions, tamponade physiology and constrictive pericarditis. And there is little data on effective therapies (figure 4).8 They conclude ‘Inhibition of the IL-1 pathway may represent a paradigm shift in the treatment of patients with recurrent pericarditis despite standard therapy.

However, larger RCT data are required for further validation of the efficacy and safety of these novel medications in the can i get ventolin over the counter uk treatment of recurrent pericarditis.’Interleukin-1 alpha and beta in pericardial inflammation. Adapted from Klein et al. 8 " data-icon-position data-hide-link-title="0">Figure 4 Interleukin-1 alpha and beta in pericardial inflammation.

Adapted from Klein et al.8The Education in Heart article in this issue provides can i get ventolin over the counter uk a quick overview of cardio-oncology for the general cardiologist. Cardio-oncology is defined as ‘the treatment and prevention of cardiovascular disease in cancer patients both during oncology treatment and afterwards.’9A basic understanding of cardio-oncology now is considered core knowledge for every cardiologist, given the demographic overlap in the prevalence of cardiovascular disease and cancer, in addition to the potential cardiotoxic effects of cancer treatments. The information and practical advice in this review article are a concise resource for busy practitioners.Our short Cardiology in Focus article10 provides a brief overview of cost-effectiveness methodology, with a short list of references for those who wish to dive deeper into this topic.Ethics statementsPatient consent for publicationNot required..