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AHRQ publishes new handbook for primary care health IT advisers, practice facilitators to help improve quality through use of clinical EHR data.

The Agency for Healthcare Research and Quality (AHRQ), in the Department of Health and Human Services, is the lead federal agency charged with improving the safety and quality of healthcare for all Americans. AHRQ develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policymakers make informed health decisions.

On May 31, AHRQ published the guide, Obtaining and Using Data in Practice Improvement: A Handbook for Health IT Advisors and Practice Facilitators, with strategies for primary care practice coaches to support improved care through health information technology.

AHRQ announced the handbookfocuses on guiding coaches as they help primary care practices collect and extract high-quality clinical data from EHRs to support quality improvement, practice transformation and efforts to implement new, evidenced-based clinical interventions.

Daniel Miller, MS, social science researcher inAHRQs Center for Evidence and Practice Improvement (CEPI), explained the purpose of the handbook in an email interview with Medical Economics.

Medical Economics: Why was this handbook published now? What is the purpose of this handbook? Why is it necessary?

Miller: While recent policy and payment changes have led to widespread adoption of EHRs, the potential of EHRs in quality improvement work hasnt yet been fully realized for a number of reasons.

From our work with practice facilitators in the field we have repeatedly heard that challenges with EHRs make it difficult for primary care practices to do things such as accurately and reliably enter EHR data, and extract data to generate quality measures and other metrics.Weve heard that many EHRs lack the functionality to produce reports that could help practices improve patient care.The large number of different EHR platforms and variations among them also present challenges.

So, the time was right for the development of this resource. The new handbook is intended to support the work of the people that are already in the field working with practices on quality improvement efforts such as practice facilitators (also called practice coaches), HIT advisers as well as practices own internal QI staff.The purpose of the handbook is to provide a practical approach to incorporating EHR data into efforts to improve care delivery and patient outcomes.

Over the last decadeAHRQhas developed extensive training resources for practice facilitators including a comprehensivepractice facilitation curriculumand most recently,practice facilitation training modules. Our new handbook is intended to be a companion resource to these practice facilitation training resources for those who are looking for a more technical treatment of how to use EHRs in QI work.

Medical Economics: How does this handbook apply to practices that are small in size, or in rural or underserved communities, where they may not have an outside Health IT Advisor?

Miller: We took practice size and location into account in the design of the handbook. Throughout the handbook there are examples and case studies that show how the general EHR strategies can be applied across different types of practices serving different populations.

The handbook assumes that users have a basic familiarity with using EHRs but it does not cover content that would be inaccessible to non-IT professionals.In general, the handbook describes functionalities that are built into EHRs as opposed to more advanced data management and analysis methods that would require programming or knowledge of the structure of the underlying EHR data.For example, the handbook describes how to generate reports and measures using built-in functions within EHR platforms instead of describing how to extract raw data and program reports.The handbook can serve as a valuable resource to any practice that is looking to improve its EHR capabilities.

Medical Economics: Physicians have complained, and studies have shown, that electronic health records can be a barrier between doctors and patients, especially in primary care. Should doctors take a new approach to EHR and think of it as a tool for quality improvement?

Miller: It is true that effective use of EHRs does take an upfront investment in training as well as potential changes in practice workflow.We have also found that many practices need additional help and resources implementing these changes and this is one of the key reasons why we developed this handbook.While there are significant start-up considerations with EHRs, there are also many potential benefits to practices.The handbook provides straightforward and practical strategies that practices can adopt to improve the quality of their EHR data and develop measures and reports that will allow them to have a better understanding of the treatment history and health of their patient population.

Medical Economics: Can you discuss some of the practical tips included in the handbook? What are some practical actions or steps physicians can do to improve their own experience with EHR and to use EHR to improve their patient outcomes?

Miller: The handbook emphasizes data clean-up and management.Getting accurate data into EHRs is one of the foundational tasks to successfully use EHRs.The handbook presents a framework for continuously monitoring the quality of EHR data with strategies for standardizing and improving the quality of data entry.This is an area that many practices have a strong interest in so they can make better use of their EHRs.

The handbook provides a tour of basic EHR functionality from an explanation of common fields within a typical EHR record to more advanced topics such as clinical decision support tools, dashboards and reports and empanelment.

Additionally, the handbook provides a detailed set of case studies that show how EHRs can support a wide range of QI initiatives.One of the goals of the handbook was to show not only how EHRs work, but also to provide specific approaches that practices can use to meet their QI goals.

Getting staff buy-in is often one of the biggest challenges to implementing EHR changes.The handbook covers strategies for working with practice staff to implement EHR improvements including developing a value proposition and identifying consensus goals within the practice, addressing resistance to changes, implementing improvement plans and reporting on progress to staff.

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Using EHR data for quality improvement focus of new AHRQ handbook - Medical Economics

When the US Supreme Court struck down the constitutional right to end a pregnancy last week, one step many Americans took was to delete an app off their phone: their period trackers.

There are hundreds of apps on the market that help users monitor their menstrual cycles, whether they are trying to conceive or avoid pregnancy altogether.

The two most popular apps in the US,Flo and Clue, are estimated to be used by 55 million Americans each month.

But when the landmark ruling that has protected abortion access, Roe v Wade, was toppled late last week, activists immediately warned of a possible future of digital surveillance.

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From period tracker apps, to online search histories and text messages, pro-abortion groups say it could all be used as evidence in a hypothetical criminal case.

Trigger bans began snapping into place immediately after Roe v Wade was overturned, with some states banning abortion from six weeks, or even from the moment of conception.

The laws vary, and while most, so far, limit penalties to those who carry out or facilitate terminations, advocates fear that politically motivated prosecutors could attempt to have things interpreteddifferently.

Analysis from the Center for American Progress published the day before the Supreme Court decision identified nine states where abortion legislation does not protect people seeking abortions themselves from prosecution.

The fear is that any information online that indicates someone may be seeking out an abortion could be used against them.

It's a scenario that has already played out to some degree. Mississippi woman Latice Fisher was charged with second-degree murder in 2017 after prosecutors used her search history and online purchasing information as evidence that she had sought out an abortion.

Ms Fisher pleaded not guilty and said while she had researched her options early in her pregnancy, she experienced a stillbirth.

A grand jury declined to recommend she be prosecuted after an autopsy concluded there was "no identifiable evidence of external or internal traumatic injury" to the stillborn baby.

It was these types of cases that had abortion advocates urging people to delete their apps as soon as Roe was overturned.

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Period trackerand fertility apps typically invite users to share a wealth of personal health information and potentially sensitive data frequency and severity of symptoms throughout the cycle, sexual activity, use of birth control, and the start and end dates of periods and pregnancies.

Given the complexities of data security and privacy, there is a growing concern that this information could easily be passed on to authorities in states cracking down on abortions.

"The concern is about how data from these period-trackingapps might be used to show that someone might have had an abortion or was thinking about getting an abortion," Swinburne University law school's Georgina Dimopoulos, a privacy expert and law lecturer, said.

"[It's] about the data you input into these apps. Where is it going? Who's using it? And how might it be handled in a criminal case in states that might proceed to legally ban abortions?

"At the moment, there's no precedent for how that data might be used in a criminal case. There is scope for it to possibly be used in this context and so that's why there's concern amongst privacy experts that using these period-tracking apps are a form of surveillance."

App developers were quick to react to concerns about the safety of the information they gather from users.

Clue said it had been inundated with questions from its customers.

"We completely understand this anxiety, and we want to reassure you that any health data you track in Clue about pregnancy or abortion is private and safe," the company tweeted.

While its terms and conditions say it complies with legal subpoenas that are issued in "good faith", the company suggested it would not honour any demands for information about Americans who may have sought an abortion.

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It also pointed out that, as a company based in Germany, it is under European Union restrictions.

"EU privacy regulation is the strictest in the world. That means we are not allowed to disclose our users' private data, regardless of where they live. And, most importantly, we would never do it," the company said.

Another app, Flo, says it will soon launch an anonymous mode thatwould give users the option to remove information from their accounts.

It may be hard for the company to reassure some customers though.

Earlier this year, the US Federal Trades Commission filed a complaint against Flo for passing on intimate details about its users to Facebook and Google.

Flo denies that it passed on the data for advertising purposes.

Natural Cycles, the first fertility app cleared by the US Food and Drug Administration to market itself as a form of birth control, says it's scrambling to develop a "completely anonymous experience for our users".

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"Our users have different beliefs, stories, goalsand journeys," the company said.

Given one Supreme Court Justice has already set his sights on revisiting legislation around contraception, developers of birth-control apps will be watching closely.

One way these apps have suggested users can protect themselves and their data is by bolstering their digital security defences.

Clue recommended adding layers of security for access to the app and enabling data remote erasure in case of a lost or stolen phone.

However,the concerns are far more wide-reaching than menstrual-tracking apps.

"I think this Supreme Court decision which clearly is a fundamental violation of women's 'decisional' privacy in the US and the flow-on effects that it has for their informational privacy, in terms of period-tracking apps should really encourage us to think about how we understand privacy," Dr Dimopoulos said.

Amid the uncertainty over how future legislation might impact rights in this area, Americans are being urged to be more strategic about their online searches, and to use virtual private networks where possible.

"I think your instinct would be to go to Google and be like, 'Am I pregnant?' [if you've] missed a period," Flinders University's senior lecturer in US History, Prudence Flowers, said.

"We have all done our own searches like that. And Google will have that information and that kind of thing can be used against people."

And it's not just people seeking abortions whoare being urged to be more careful online.

Since Friday, social media has lit up with offers of help from people in states where abortion remains unrestricted, many openly declaring,"I will aid and abet abortion", while others use coded messages to reach out.

"I live in Illinois, a state where the right to go camping is actually a law," one Twitter user posted.

"I have a spare tent & can provide transportation to a campsite."

Privacy advocates warn that this kind of information could be used against people under so-called abortion "bounty hunter" laws.

First established in Texas, and subsequently pursued by Michigan and Idaho, these laws allowprivate citizens to sue anyone who helps another person access an abortion.

Anyone from the doctor who performs the procedure to the driver who takes the patient to the clinic can be sued.

In Texas, for instance, a plaintiff who brings the case is rewarded with $US10,000 and their legal fees are covered by the state.

"I think people have been making claims on social media about like ... they'll host people in their homes," DrFlowers says.

"People need to be much more circumspect in terms of what information they put out on social media about what they're willing to do for people who need abortion care."

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With Roe v Wade gone and abortion banned in some US states, Americans are deleting their period tracker apps - ABC News

Emmanuel Macrons centrist grouping has lost its absolute majority in parliament, amid gains by a new left alliance and a historic surge by the far right, according to projected results in Sundays election.

After five years of undisputed control of parliament, the recently re-elected Macron, known for his top-down approach to power, now enters his second term facing uncertainty over how he will deliver domestic policies, such as raising the retirement age and overhauling state benefits. His centrists will need to strike compromises and expand alliances in parliament to be able to push forward his proposals to cut taxes and shake up the welfare system.

Macrons Ensemble (Together) remains the biggest grouping in parliament, but suffered significant losses in what the media called a crushing defeat and an earthquake. Political analysts deemed the results a severe failure for Macrons centrist alliance, which missed the absolute majority by a large margin, in contrast to its landslide win five years ago.

Projections by Ipsos pollsters, based on partial results, showed that Macrons centrists would win about 234 seats much less than the 289 required for an absolute majority in the National Assembly.

A historic alliance of parties on the left, led by the hard-left Jean-Luc Mlenchons France Unbowed party with the Socialists and the Greens, seemed poised to become the largest opposition group, with about 141 seats.

But the most striking result of the night came for Marine Le Pens far-right, anti-immigration National Rally party, which was forecast to increase its seats from eight in 2017 to about 90 a historic high for a party that in the past has struggled to make gains in the first-past-the-post parliamentary voting system.

The far-right gains showed that Le Pens party had expanded from its traditional heartlands in the Pas-de-Calais across a swathe of the north and north-east, and spread from its south-eastern base along the Mediterranean coast.

Significantly, the far right broke new ground in western France, with a rising party star, Edwige Diaz, 34, winning a seat in Gironde outside Bordeaux, in an area where the gilets jaunes anti-government protests had been very strong. The partys high number of seats will allow Le Pen, who was elected in the Pas-de-Calais area, to form a major parliamentary group and receive greater visibility and significant funding for her party, which is facing debts.

Le Pen gave a victorious speech from northern France, saying her party had won its greatest number of members of parliament in history. We will be a firm opposition, she said. Her interim party leader, Jordan Bardella, called it a tsunami.

Mlenchons France Unbowed party now leads a broader left coalition, known as the Nupes, or the New Popular Ecological and Social Union. Within the left alliances projected 141 seats, the Green party increased its showing to about 28 seats and the Socialists took about 22. Clmentine Autain, a close ally of Mlenchon, described the united lefts result as a breakthrough. The lefts Rachel Keke, a hotel housekeeper who led a strike for better pay and conditions at a Paris hotel, became the first cleaner ever elected to the French parliament.

Macrons centrists insisted they had still come top, even if the mood at party headquarters was described as grim.

Its a disappointing first place, but its a first place, said Olivia Grgoire, a government spokesperson, on French TV. She said the government would ally with moderates who wanted to move things forward but did not spell out how Macrons grouping would avoid deadlock over legislation.

The economy minister, Bruno Le Maire, called the results a democratic shock which he defined by the big push of the far right. He said the results reflected the big worries of the French electorate, but Macrons policy plans could still be resumed as work, security, Europe, climate.

Le Maire said Macron was the only person to have the democratic legitimacy to decide that project and to reach out a hand to others in parliament to move forward. He said he did not believe there would be chaos in parliament and that the results were disappointing, but not a defeat.

Macron, who was re-elected president in April over Le Pen, had pleaded for a solid majority in parliament in order to have a free hand to deliver domestic policy.

But his party, La Rpublique En Marche, which is soon to be renamed Renaissance, suffered several symbolic defeats as key figures in Macrons circle were voted out. These included Christophe Castaner, the former head of Macrons party in parliament. Richard Ferrand, an architect of Macrons centrist movement and the former head of the French parliament, was ejected from his seat in Brittany.

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The presidents party will now be more dependent than ever on its centrist allies, which include former prime minister douard Philippes new party, Horizons. The government could shift further right if it needs to court rightwing legislators.

Macron will be forced to reshuffle his government in the coming days, after the new health minister, Brigitte Bourguignon, was beaten by the far right in the north, and the environment minister, Amlie de Montchalin, lost her seat. The prime minister, lisabeth Borne, was elected in Normandy, but her result was closer than expected.

Borne described the election result for the centrist grouping as a risk for our country in view of the challenges we have to face, saying the government would immediately try to find consensus to guarantee stability.

The election was marked by voter apathy, with less than 50% of the electorate turning out to vote.

The rightwing party Les Rpublicains, which was in power under Nicolas Sarkozy, suffered losses, but was still predicted to keep hold of about 75 seats. This was seen as a respectable showing after its catastrophic score in the presidential election, when its candidate, Valrie Pcresse, took less than 5%. The right and its centre-right allies, the UDI, could now be courted as potential parliamentary allies for the government.

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Macrons centrist grouping to lose absolute majority in parliament, say projected results - The Guardian

The new changes affect Provisions on the Management of Internet Post Comments Services, a regulation that first came into effect in 2017. Five years later, the Cyberspace Administration wants to bring it up to date.

The proposed revisions primarily update the current version of the comment rules to bring them into line with the language and policies of more recent authority, such as new laws on the protection of personal information, data security, and general content regulations, says Jeremy Daum, a senior fellow at Yale Law Schools Paul Tsai China Center.

The provisions cover many types of comments, including anything from forum posts, replies, messages left on public message boards, and bullet chats (an innovative way that video platforms in China use to display real-time comments on top of a video). All formats, including texts, symbols, GIFs, pictures, audio, and videos, fall under this regulation.

Theres a need for a stand-alone regulation on comments because the vast number makes them difficult to censor as rigorously as other content, like articles or videos, says Eric Liu, a former censor for Weibo whos now researching Chinese censorship at China Digital Times.

One thing everyone in the censorship industry knows is that nobody pays attention to the replies and bullet chats. They are moderated carelessly, with minimum effort, Liu says.

But recently, there have been several awkward cases where comments under government Weibo accounts went rogue, pointing out government lies or rejecting the official narrative. That could be what has prompted the regulators proposed update.

Chinese social platforms are currently on the front lines of censorship work, often actively removing posts before the government and other users can even see them. ByteDance famously employs thousands of content reviewers, who make up the largest number of employees at the company. Other companies outsource the task to censorship-for-hire firms, including one owned by Chinas party mouthpiece Peoples Daily.The platforms are frequently punished for letting things slip.

Beijing is constantly refining its social media control, mending loopholes and introducing new restrictions. But the vagueness of the latest revisions makes people worry that the government may ignore practical challenges. For example, if the new rule about mandating pre-publish reviews is to be strictly enforcedwhich would require reading billions of public messages posted by Chinese users every dayit will force the platforms to dramatically increase the number of people they employ to carry out censorship. The tricky question is, no one knows if the government intends to enforce this immediately.

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China wants all social media comments to be pre-reviewed before publishing - MIT Technology Review

Justin Bonsignore celebrates in Victory Lane after winning the Duel at the Dog 200 at Monadnock Speedway on Jun. 19, 2022. (Nick Grace/NASCAR)

In a season filled with positives and negatives, luck was on Justin Bonsignores side during the closing laps of Sundays Duel at the Dog 200 at Monadnock Speedway.

Contact between race leader Matt Hirschman and the lapped car of J.B. Fortin with three laps remaining created an opportunity for Bonsignore to slip past them on the bottom for his second victory on the 2022 NASCAR Whelen Modified Tour.

Bonsignore was prepared to settle for a second-place finish but was stunned that Fortin essentially gifted him the victory by interfering with Hirschman.

Id guess youd rather be lucky than good any day, Bonsignore said. Matt [and I] were neck-and-neck, but Im not sure whats going between [him and Fortin]. I could kind of see it coming from a mile away, so I got into [Turn 3], hooked the bottom and stood in the throttle for the first time all day.

RELATED: Results from the Duel at the Dog 200 at Monadnock Speedway

Good luck has been hard to come by for Bonsignore through the first five races.

Despite getting an early victory at Richmond Raceway, Bonsignore had not recorded another finish inside the Top 5 prior to Saturdays Duel at the Dog 200. The mixture of poor performances and mechanical issues relegated Bonsignore to seventh in the Modified Tour standings; 37 points behind leader Ron Silk.

Mother Nature cut Bonsignore a break when persistent rain showers on Saturday evening resulted in the starting lineup being set by practice speeds. Bonsignores time of 12.854 allowed him to start on pole for the rescheduled Duel at the Dog 200 on Sunday.

Bonsignores lead only lasted a handful of laps before he was passed by Hirschman. With plenty of time at his disposal, Bonsignore took care of his equipment and watched as Silk chased down Hirschman to take control of the race.

Silk proved to be untouchable for most of the afternoon but admitted that his car started to fall off as the race neared its conclusion, which forced him to settle for a third place finish behind Bonsignore and Hirschman.

Like Bonsignore, Silk was puzzled by Fortins decision to block Hirschman and cost him the victory.

[Fortin] just ran [Hirschman] all over the track and it looked like it was intentional, Silk said. It didnt really affect my finish, which was right about where it should have been. I had a great car the whole race but I ran out of grip with about 20 laps to go. It was a good effort and we led a lot of laps, which is all you can do.

Even though he did not get a win, Silk still managed to bolster his small points lead with Tommy Catalano and Jon McKennedy both enduring inconsistent afternoons.

Silk has yet to find Victory Lane so far in 2022 but he envisions a win coming to pass sooner rather than later with how efficient he and his team have been with six Top 10 finishes in six races.

You never know when youre going to have some sort of trouble, Silk said. Were just going to keep doing what were doing, but we need to be up here racing for the lead and get Top 3s. Im pretty confident going to all of these tracks and with the team that we have, we can knock off a win anywhere.

Silk knows that consistency will be imperative over the next several weeks, as he is expecting Bonsignore to be a part of the championship conversation once the season finale at Martinsville Speedway arrives in October.

Bonsignore is not used to facing points deficits this large shortly before the halfway point of a season, but he is still confident that he can shake off the bad luck and put together performances worthy of a fourth Modified Tour title.

With one of his favorite tracks in Riverhead Raceway next up on the schedule, Bonsignore is ready to start his turnaround when the next green flag flies.

Its good to get back [to Victory Lane], Bonsignore said. We were going to have a good run either way, but this is what you have to do to win these races. Weve really been struggling these past few weeks and Im just happy to finish on the lead lap. Sure enough, we won as well.

Sam Rameau and Doug Coby rounded out the Top 5 finishers at Monadnock. Completing the Top 10 were Eric Goodale, Jake Johnson, Austin Beers, Catalano and Jacob Perry.

A replay of Sundays Duel at the Dog 200 at Monadnock Speedway can be seen on the USA Network on June 25 at 11 a.m. ET.

The NASCAR Whelen Modified Tour will be back at the track next weekend for their second visit to Riverhead Raceway in Riverhead, NY on Saturday evening. The race will be broadcasted live on FloRacing.

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Justin Bonsignore steals a victory in the Duel at the Dog 200 - NASCAR