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    Rhode Island Quality Institute is using its statewide health information exchange to send real-time notifications for care transitions to and from emergency departments and hospitals. The alerts include direct messaging, EHR notifications and real-time dashboards.

    Elaine Fontaine, director of data quality and analytics at RIQI, says sharing that real-time information with providers across Lil' Rhody is leading to some worthy gains in efficiency and care quality.

    CurrentCare, Rhode Island's statewide HIE, was launched in 2006, and RIQI took over the maintenance of its data in 2010.

    "We have more than 400 data sharing partners in Rhode Island," said Fontaine. "All of the acute care hospitals are delivering to us admission, discharge and transfer data as well as continuity of care documents. We're getting the vast majority of ambulatory radiology and lab results. We are also connected to more than 200 ambulatory practices, as well as to Surescripts."

    That's a pretty robust data set. And Fontaine – who'd worked at a health plan and at a large integrated delivery system before joining RIQI in 2014 – said the idea of diving in to find new and innovative uses for it all was "wildly appealing."

    After all, she said, "having data across multiple platforms, not bounded by geography or payer or provider, was very powerful with regard to being able to aggregate and deliver data to various stakeholders in a way that would really impact health.

    "That vision was always part of RIQI's thinking as they built out the HIE," she added. "Many other states really have this federated point-to-point model without the data being maintained in a centralized source. But RIQI understood that to be able to leverage the value of that data, maintaining it over time was critical."

    From the get-go, data integrity was a primary focus for CurrrentCare. "Rhode Island focused on governance before they focused on the technology of the HIE," said Fontaine. "Ensuring data governance across the community, and having everybody onboard with the model and the security and the understanding of how the data was going to be delivered and used really eased the opportunity to make this work."

    Competitive concerns among various stakeholders took a back seat too. The key, she said, "is that the patient is the North Star. And whenever there were challenges or concerns about data sharing, the ability to say, 'If the patient shows up at your doorstep and there's information in someone else's EHR that can save that patient's life, is there a reason to not allow that data to flow?' That kept the conversation honest at all time."

    Near real-time data helps nurse care managers prioritize interventions
    A couple years ago, RIQI started some talks with a forward-thinking CEO at one of Rhode Island's federally qualified health centers, which had received some funding from the Jessie B. Cox Foundation that could enable a pilot to better leverage HIE data for efficiency gains.

    "He said, 'I have many processes in place, and when a patient is admitted or discharged from the ER or the hospital, I have a large number of staff doing document management, and they're getting faxes and electronic notification and phone calls,'" Fontaine explained. "'It's administratively inefficient. Sometimes we get many notifications and sometimes we get none. Our ability to efficiently manage care coordination is a challenge for us. Is there a way that the HIE can help?'"

    The result was a dashboard – "simple and elegant and powerful" – that shows the provider three charts.

    "One is just is just a bar graph showing the number of patients in the emergency room or in the inpatient hospital," she said. "The next is a bar chart looking at the last four days of discharges (ER and inpatient). And then the bottom is a run chart, over the last 12 months, of the number of admissions to the emergency room and inpatient settings. So if somebody was actually running an improvement project doing a PDF/A, they could actually see the impact of their intervention without having to go look for that data somewhere else."

    The benefits became apparent pretty quickly, said Fontaine: "When the care manager dove into, let's say, the people who were discharged from the emergency room yesterday, to do discharge follow-up, they get a listing of those patients: what facility they were in, what the reason for admission was, and a variety of demographic related information."

    And iterative adjustments have only improved it, she said. "We have added to that a simple calculation that folks had been trying to pull together manually from all of the faxes and pieces of paper, which is the number of times the patient has been to the ED or the inpatient setting in the past six months. And this data is updated every 45 minutes."

    The ability to sort by patient has been a boon to overburdened providers, said Fontaine. "If you're the nurse care manager and you have to prioritize who you're calling first today because you have a limited amount of time, to do followup for people who were discharged yesterday, you sort on those who have been to the ED most.

    "Every single time we do it, we see people who have been to the ED 80 times, 90 times, 100 times in the past six months," she added. "You're looking at the admission reason and the number of times they've been admitted. So if you're looking at someone whose admission reason is chronic pain, and they've been there 100 times, your response as a nurse care manager is going to be very different than if you get to the bottom of your list and you see lacerations and this is the first time they've been in. So who do you call first?"

    Having data in near real-time is an obvious win for nurse care managers who are often "spending upwards of 15 hours a week chasing data," said Fontaine.

    Moreover, "they're waiting sometimes as long as 48 hours after discharge to know it," she said. "Now we're telling you in an hour. And in a way that's organized in one place so you can actually prioritize and act on it."

    Fontaine, with her RIQI colleague Alok Gupta, will present "Expanding Real-Time Notifications for Care Transitions," on Tuesday, Feb. 21, 2017 from 10-11 a.m. in Room 304A.

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    NorthShore University HealthSystem gained Stage 7 revalidation from HIMSS Analytics for its hospitals and associated clinics, again attaining the highest level on both the acute care Electronic Medical Record Adoption Model and outpatient EMRAM.

    The four-hospital system based near Chicago, manages patients using real-time, actionable analytics, monitoring 16 evidence-based quality measures for preventive care and chronic conditions. Using a custom dashboard within NorthShore's integrated EHR, care providers can more quickly assess individual patients with care gaps such as missed follow-up appointments, diabetes exams and preventative services such as screenings and immunizations.

    Patients at high risk for hospital readmission can then be flagged prior to discharge and referred to the appropriate provider for follow up in the physician office, HIMSS officials said. An automated outreach system is triggered that contacts the patient using their preferred method of communication.

    "NorthShore University HealthSystem's use of analytics exceeds expectations by not only using the data to improve clinical care and operational efficiency, but to also learn how to improve the workflow of the physician, saving time and improving documentation," said Philip Bradley, regional director, North America, HIMSS Analytics.

    "At the same time, they continue to innovate, with implementing closed-loop blood product administration and recently began smart pump integration throughout the inpatient environment," he said.

    NorthShore's digital health initiatives have expanded functionality and usability to simplify the healthcare experience for patients, and enabled the potential for 80 percent of physician and hospital appointments to be booked online.

    Mary Keegan, RN, NorthShore's chief nursing officer, said the health system has harnessed IT to improve patient care and increase efficiency in several ways, "from enhancing timely access via online appointment scheduling, to getting lab and test results to the patient — oftentimes before they have arrived home from the lab.

    "We live in an on-demand world, and the EHR enables the team to communicate in a standardized and efficient manner," she added. "The complexity of the inpatient world is cemented with readily available information shared amongst multiple team members, enabling modification of treatment plans in real time. Most importantly, patient safety is enhanced with clinical guidelines and recommendations to the caregivers."

    NorthShore University HealthSystem will be recognized for its Stage 7 award at HIMSS17.

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    The healthcare industry was riddled with cybersecurity issues in 2016 as ransomware, human error, IoT flaws and hacking attempts were some of the biggest problem areas.

    The good news is that it appears the industry is taking notice and attempting to secure its vulnerabilities. The bad news? There is still a long way to go to protect valuable patient data and keep it out of cybercriminals' hands.

    We spoke with four security experts: ESET Security Researcher Lysa Myers; CynergisTek co-founder and CEO Mac McMillan; ICIT Senior Fellow James Scott; and Pam Hepp, shareholder, healthcare practice at Buchanan, Ingersoll & Rooney.

    Here's what they said organizations need to be doing this year to reduce their vulnerabilities:

    1. Risk assessments. "Most organizations have limited funding," Myers said. "Risk assessments help identify what really needs to be protected, and how to get the best bang for the buck for your security budget." Further, clear documentation can help security teams plead the case for funding. Hepp added organizations should make recommendations based on assessments to address vulnerabilities.

    2. Disaster recovery and contingency plans. An effective plan addresses not only access to medical and billing records, but contingencies for email, departments reliant upon the network and departments with high-tech equipment like, lab, pharmacy or imaging services, Hepp said. McMillan explained practicing the plan is crucial: "Involve staff, not just IT or managers in exercises, consider worst case scenarios for loss of power, communications, network and others to ensure staff can actually do their job without the system."

    3. Dedicated Sec-Op teams."Depending on 'Bob the IT guy' who is not a security expert to defend a network is not effective," Scott said. Organizations need a dedicated Sec-Op team to handle security, hunt threats, educate staff on latest threats and perform pen tests.

    4. Business associate/vendor scrutiny. Organizations must thoroughly vet business associates by reviewing vendors' risk assessments and requiring indemnification provisions and cybersecurity insurance in business associate agreements. For Scott, organizations should pick vendors with a demonstrated track record with 'security by design' – a security method that uses continuous testing, authentication safeguards and adherence.

    5. Better employee training."Most companies train once, if at all, and may never revisit the information," Myers said. "By comparison, most places have fire drills regularly and frequently, so that employees will know without thinking what they need to do in an emergency." Education also needs to be simplified, to make it easier to understand and commit to memory. According to Hepp, organizations should conduct mock phishing attempts to raise staff awareness. For McMillan, organizations must go deeper: "Computer-based training may be easy, but it is hardly effective," he said. "Use multiple platforms, but ensure that some methods used involve experiential learning such as tabletops, exercises and tests, among others."

    6. Layered defense. "Many organizations are under the delusion they can detect and respond, and they're not layering their defenses," Scott said. "The CISO should be looking at targeted areas where he or she can add to various layers of cyber defense. But there's still not enough movement in this area."

    7. Improved tech hygiene. System upgrades and patches must be up-to-date and routinely checked minimize system vulnerabilities and hacking attempts. Hepp explained systems must also be routinely monitored for inappropriate activity. And, as always, back-up systems to prepare for ransomware attacks or other system outages. Scott extended this further to "securing equipment within that IoT microcosm, which will thwart a lot of those exploits that are so readily available."

    8. Cybersecurity partnerships. Partnering with the right organizations can assure the success of your cybersecurity strategy: for resources, expertise, experience and capabilities, McMillan said. "Areas like risk analysis, testing, incident response, activity monitoring, security analysis are all good candidates for achieving greater efficacy." Additionally, organizations need to "embrace sharing of cybersecurity information. For example, initiate a local or regional ISAO Standards Organization with other healthcare entities in your region."

    9. Better software. While there is "a whole litany of technologies" healthcare organizations should consider, McMillan said his short list would include: next-generation firewalls, advanced malware detection, email and web gateways, multi-factor authentication, encryption, vaulting solutions and outsourcing security information and event management – among others.

    10. Forensic consultants. Before an organization faces a crisis, Hepp said organizations should engage a forensic consultant to provide insights on weaknesses, liabilities and security reports.

    Twitter: @JessieFDavis
    Email the writer: jessica.davis@himssmedia.com


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    Max Stroud, aka @MMaxwellStroud, is a lead consultant with Galen Healthcare Solutions and the founder of Doyenne Connections, a social network designed to foster opportunities for women in health IT. And at HIMSS17 she will a Social Media Ambassador.

    Healthcare IT News asked Stroud about her pet peeves, health IT hero and what is top-of-mind among her social media followers.

    Q: What are you most looking forward to at HIMSS17?
    A:
    I am really looking forward to sharing the experience with my sister. My friends and family don’t always understand exactly what it is that I do, so getting to show someone what HIMSS is like – and for that person to be my sister is pretty amazing.

    Q: What issues do you think are top-of-mind for your social media followers?
    A:
    My followers are pretty diverse, and I see three things as top of mind when I look at the group as a whole. First: What to do with all that data. We’re reaching a point in time when people have been live on EHRs for so long, that some systems are getting sunset, some are getting retired in favor of new ones — and finding the right way to deal with that legacy data over time has been a big discussion point. Second: Putting the Patient in the center. We have a system today where health data flows around physical locations and not individuals. This comes up time and again in online chats in HealthIT circles and in patient chats. The desire for the patient to be the central point in a record and all of their data from all points to be connected is palpable. Third. Gender Parity — 70-80 percent of healthcare workers are women, and yet they make up only a small percentage of executive teams. My followers are passionate about shaking this up and ensuring that there is room for everyone in the C-suite and beyond.

    Q: Who's your favorite healthcare hero? Why?
    A:
    I just love Karen DeSalvo. She is one of the most approachable government officials that I have ever met. I remember hearing an interview where she talked about her true north in regards to her work. She has a passion to make the world a better place. I can identify with that.

    Q: What's your pet peeve? (Either on- or off-line?)
    A:
    I have a really hard time with complainers.  Complaining just to complain turns me off. If there is a problem, let’s come up with some ideas and possible solutions and talk about that.

    Q: What is something your social media followers do not know about you?
    A:
    I had bylines in a major newspaper before graduating high school. I had both photographs and an Op-Ed published in the Philadelphia Inquirer. Most people don’t know my first name — it is used only by my immediate family. And I have a very distinctive sneeze. 

    Related HIMSS17 Social Media Ambassadors: 
    ⇒ Meet Drex DeFord: Former Air Force CIO who started as a rock-n-roll DJ

    ⇒ Health IT guru Brian Ahier: A big fan of analytics, Don Berwick and Jerry Garcia
    ⇒ Linda Stotsky: She writes poetry, sticks up for underserved and loves ... boxing? 
    ⇒ Charles Webster: Find him in the first Innovations Makerspace at HIMSS17

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


    Like Healthcare IT News on Facebook and LinkedIn


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    Eligible hospitals and critical access hospitals participating in the Hospital Inpatient Quality Reporting program and/or the Medicare EHR Incentive Program will have a bit of extra time for submission of electronic clinical quality measures.

    In a Jan. 17 blog post, Kate Goodrich, MD, director of CMS' Center for Clinical Standards and Quality, said those hospitals submitting eCQM data for the 2016 reporting period (pertaining to the FY 2018 payment determination) will now have until Monday, March 13, at 11:59 p.m. PT, rather than the last day of February.  

    CMS also has plans to make some modifications to eCQM requirements as laid out in the FY 2017 Inpatient Prospective Payment System final rule.

    "In order to help reduce reporting burdens while supporting the long term goals of these programs, we intend to include proposals regarding the 2017 eCQM reporting requirements for the Hospital IQR and EHR Incentive Programs for eligible hospitals and critical access hospitals in the FY 2018 IPPS proposed rule that we anticipate to be published in the late spring of 2017," Goodrich wrote.

    "Specifically, in the FY 2018 IPPS proposed rule, CMS plans to address stakeholder concerns regarding challenges associated with hospitals transitioning to new EHR systems or products, upgrading to EHR technology certified to the 2015 Edition, modifying workflows and addressing data element mapping, as well as the time allotted for hospitals to incorporate updates to eCQM specifications in 2017," she added.

    Goodrich said CMS is also mulling a modification of the number of eCQMs that have to reported for 2017, and a potential shortening of the reporting period.

    "We believe that these efforts reflect the commitment of CMS to create a health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the healthcare providers who care for patients," she wrote. "We continuously strive to work in partnership with hospitals and the provider community to improve quality of care and health outcomes of patients, reduce cost, and increase access to care."

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com


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    Ask Pamela Arora, who was just named CIO of the Year by CHIME and HIMSS, about her career achievements and she quickly moves the spotlight to her staff.

    “My proudest achievement as a CIO is leading a high-performing team,” she said.

    Arora rattled off several examples: Children’s Health in Dallas climbed to Stage 7 on the HIMSS Analytics EMRAM scale, obtained HITRUST Common Security Framework Certification, was named a Most Wired Hospital, earned an AHIMA Grace Award for taking innovative approaches to using health information management and snagged an AHA-CHIME Transformational Award for its work in cybersecurity, among others.

    Healthcare IT News asked Arora what she perceived to be her greatest strength as a CIO, whether as a woman in technology she encountered inequity, and her about her primary professional mission.

    Q:  What drew you to a career in healthcare IT?
    A:  
    While we all have a personal story that involves healthcare, we all have one thing in common. Whether we are the patient, or one of our loved ones is the patient, we want our physicians and clinicians to have every resource to be able to deliver the best possible care. This is what drew me to a career in healthcare IT. While technology may not always be visible, our work makes a difference in the lives of patients – in our case, we are making life better for children. What could be better than that?

    Q:  What do you think is your biggest strength as CIO, and what are you working to improve?
    A:
    I believe my biggest strength as a CIO is my understanding of both the technology and healthcare fields. Early in my career, I had the opportunity to gain exposure to multiple industries – and valuable insights from those experiences. However, the last 15 years of my career have been focused in the healthcare industry. I have found that a deep knowledge of healthcare is critical because of its regulatory implications and the complicated nature of the work across the continuum of care both inside and outside the walls of the organization.

    One of the areas we’re continuously working to improve is the understanding and adoption of a culture in which data security remains in the forefront. As the cybersecurity landscape continues to evolve, we are working to promote awareness and education of cybersecurity threats and defenses so that our organization and patient data remains secure.

    Q: As a woman in health IT, have you ever encountered inequity in pay or otherwise?
    A:
    I have been fortunate to work in organizations where there’s a great deal of diversity, and the individual’s ability to contribute was more important than gender. Because of these experiences, I haven’t perceived a great deal of inequality personally. Yet we know that the issue exists.

    If you look at the Department of Commerce, Economics and Statistics Administration report, Women in STEM: A Gender Gap to Innovation, there is still a gap; however, I’m encouraged that the gender gap in pay for women in STEM careers is smaller. Anecdotally, having worked in other industries, I believe that healthcare has made a great deal of progress on this front, and I’m pleased to be a part of an industry where the gap is shrinking. There is still work to do, and it’s incumbent on each organization to value the contributions of its people, regardless of gender or any other perceived differentiator.

    Q: What do you view as your primary mission as CIO?
    A:
    We have a sacred responsibility at Children’s Health; we are entrusted to care for some of the most fragile patients in the community. My primary mission is to make sure we have the technology, tools, and people to facilitate the highest levels of care for our patients and their families.

    Q: What is your proudest achievement?
    A:
    From a personal standpoint, my proudest achievement is my lovely, bright, and talented daughter (she is pursuing a STEM education), who definitely makes life better for me!

    From a career standpoint, my proudest achievement as a CIO is leading a high-performing team. I’m fortunate because I get to work with an excellent team of dedicated technology professionals. We work for an organization that has a strong willingness to adopt and innovate healthcare with technology tools, and we do it all in support of our mission: to make life better for children.

    Arora will receive the CHIME and HIMSS CIO of the Year award on Feb. 21, 2017, at the HIMSS Annual Conference & Exhibition. 

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    Rep. Tom Price, MD, the Georgia Republican tapped by President-elect Donald Trump to be the next U.S. Secretary of Health and Human Services, spent four hours testifying before the Senate Health, Education, Labor and Pension Committee on Jan. 18.

    Most of the hearing focused on the expected topics: the future of the Affordable Care Act, the scope of Medicare and Medicaid, Price's questionable investments in medical device and drug companies.

    But toward the end of the testimony, Republican Louisiana Senator Bill Cassidy, MD, asked Price to weigh in on health information technology.

    "Franken calls me a Luddite, because I am skeptical about electronic health records and their negative impact upon productivity," said Cassidy, referring to fellow HELP Committee member Al Franken, D-Minnesota.

    "I see that MD Anderson just laid off 5 percent of their staff," said Cassidy. "They're blaming it upon financial losses based on decreased productivity, again directly attributable to the implementation of their EHR."

    He asked Price: "What can we do about this time and productivity sump that has become the electronic health record and meaningful use? Keeping that which is positive, but hopefully doing something better for the patient and the physician."

    [Also: Updates: Tom Price faces tough questions in Senate confirmation hearing for HHS secretary post]

    "Electronic health records are so important because, from an innovation standpoint they allow the patient to have their health history with them at all times and be able to allow whatever physician or provider to have access to that," Price responded. "We in the federal government have a role in that, but that role ought to be interoperability: to make sure the different systems can talk to each other so it inures to the benefit of the patient.”

    With regard to the EHR Incentive Program, "I've had more than one physician tell me that the final rules and regulations related to meaningful use were the final straw for them," said Price. "And they quit. And they've got no more gray hair than you or I have. And when that happens we lose incredible intellectual capital in our society."

    Said Cassidy: "I often find an orthopedic surgeon asking someone about their smoking history is not really a good use of an orthopedic surgeon's time. Not that it isn't important, but he's not the person that would institute the cessation program."

    "I think what's absolutely imperative is to find out what things ought to be determined and checked, the metrics that are used – that they actually correlate with the quality of care that's being provided as opposed to so many things that are required right now of the physician or the provider that make is so they're wasting their time documenting these things so that it sits in some matrix somewhere but doesn't result in a higher quality of care or outcomes for that patient," said Price.

    Sen. Cassidy then turned the conversation to the future of medicine and the economics of "expensive medicines used only by a few," such as gene therapy that could combat antibiotic resistant bacteria. How should that be paid for "in the era of personalized medicine, where it might be an n = 1 or an n = 1000 – still very small but the cure could be a million"?

    "We're entering a brave new world that is so exciting from a scientific standpoint," said Price. "To be able to provide this sort of personalized healthcare to folks, we'll be able to cure things that we never dreamed about curing. The challenges of how we afford to be able to make that available to our society are real, and I think we need to get the best minds together to make that happen, and I look forward to working with you to do so.

    "Incentivization from an FDA standpoint is incredibly important," Price continued, "to make sure that if companies come up with things that are able to cure diseases, that they are appropriately compensated for it."

    As the hearing drew to a close, HELP Committee Chair Lamar Alexander, R-Tennessee, thanked Price for undergoing what he said was "the most extensive questioning of any Secretary of Health and Human Services since 1993." And he took one more swipe at meaningful use.

    "At Vanderbilt, which was an early adopter of electronic healthcare records, they said Stage 1 was helpful, Stage 2 they could deal with and Stage 3 was terrifying," said Alexander.

    "I had hoped we could delay Stage 3," Alexander added. "I thought it could be as simple as saying to the physicians and providers of the world, 'Look, if you're a physician and you're spending 50 percent of your time filling out forms, then either you're doing something wrong or we're doing something wrong. And let's work together over the next couple years to get that down to a manageable level and create an environment where physicians and providers can spend their time talking instead of typing.

    "You've got a bipartisan consensus here to work on that," he told Price. "At least we did last year when we passed the (21st Century) Cures bill. I invite you to work with us, if you're confirmed, to complete that."

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com


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    Peter Basch, MD, senior director of health IT quality and safety, research and national health IT policy for Washington, D.C.-based MedStar Health, has received the 2016 HIMSS Physician IT Leadership Award.

    Basch provides policy and clinical leadership for the post-regulatory optimization of health IT at MedStar and spends about 20 percent of his time as a primary care internist. Previously, he focused on EHR implementation and regulatory compliance, like Medicare e-prescribing and meaningful use.

    The award, which is jointly sponsored by AMDIS and HIMSS, recognizes a physician each year who demonstrates leadership in optimizing patient engagement and care outcomes by leveraging health information technology. Both of the organizations' boards of directors selected Basch as the recipient.

    "Peter Basch is a gentleman physician who demonstrates a perfect combination of clinical compassion, scholarly erudition and wonderful good humor. It is an honor and a privilege to call him a friend," said AMDIS Chair William F. Bria, MD, in a statement.

    [Also: Physician's IT Symposium at HIMSS17 to focus on interoperability, cybersecurity, precision medicine]

    "Peter has been highly involved with HIMSS and AMDIS for 15 years," added Pat Wise, vice president, health information systems at HIMSS North America. "He's a deeply respected thought leader and has been a significant contributor to a wide array of HIMSS' committees, task forces and work groups."

    Basch will be honored for his achievement at the Awards Gal on Feb 21, 2017 at the HIMSS Annaul Confernce & Exhibition. 

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center in Orlando, Florida. 


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    Mercy, the St. Louis-based Catholic health system with 43 hospitals and 700-plus physician practices across Missouri, Arkansas, Kansas and Oklahoma, has won a 2016 HIMSS Davies Enterprise Award.

    HIMSS is recognizing Mercy for its EHR optimization, process improvement efforts, use of evidence-based protocols and analytics gains – all of which have helped the health system lower costs, improve care quality and patient outcomes and increase reimbursements. They're descibed in a series of case studies on the HIMSS website.

    With an aim toward improving care coordination and reducing overtreatment, Mercy configured evidence-based protocols within its EHR system that enabled it to tackle an array of tricky challenges.

    For one, recognizing that it wasn't achieving optimal treatment for Medicare and Medicaid patients with heart failure, Mercy sought to improve quality through standardization for selected patient populations. Heart failure mortality rates for patients was at the national average of 6 percent prior to implementation of the new pathway, which achieved reductions in that rate.

    Pneumonia mortality was also at the national rate 4 to 5 percent, but an an itiative to expedite the delivery of antibiotics via new pathway order set reduced the time it took for the drugs to be administered by approximately three hours.

    Mercy also enacted a clinical documentation improvement project that found, upon closer review of patient records, many areas that could be addressed by better charting. It rolled out a tool that provides more accurate and timely documentation, standardizes workflows with best practices, and gives actionable data to enhance communication with physicians. The MDS Operational Analytic Tool and the Secondary Diagnosis Report provides MDS users a standardized workflow process across the organization.

    In another initiative, Mercy's perioperative leaders looked for new ways to monitor, measure and improve the hospitals' surgical procedures while also increasing patient satisfaction. It implemented a dashboard whose analytics data have helped save  2,300 man-hours a month for each of its locations and helped the health system achieve a total savings of $9.42 million across its perioperative departments. 

    Mercy will be honored with the award during a ceremony at the HIMSS Conference & Exhibition in Orlando, Florida. 

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    To say that a lot has changed in healthcare since last year’s HIMSS conference is an understatement. Right now, a new Congress and a new Administration are wrestling with how to repeal and replace the Affordable Care Act, the signature health reform law of the Obama Administration.

    Despite all that's changed, one thing has not: the move from fee-for-service to value-based care. Not only is this a transformation that pre-dates the Obama years and the ACA, but thanks to the overwhelmingly bipartisan Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, the shift to value is enshrined in our law, and will survive any changes to the ACA.

    To make value-based care work, however, we need data – lots of it, and free flowing. When doctors are on the hook for the full cost of care, they need to know: what interventions work and which do not; who has been to the ER and needs follow-up care to prevent a costly readmission; who has not been in the office in a while and may be at risk for a complication; and the list goes on and on.

    Harnessing all of this data and making it useful has been a huge undertaking for physicians and hospitals, for health IT developers, for regulators, for us all. While at times it may be frustrating, we have seen significant progress in health IT since I started working on its dissemination as part of the Office of the National Coordinator of Health IT in 2009.

    Thanks to the massive investment in health IT as part of the American Recovery and Reinvestment Act, the percentage of office-based physicians with an EHR system more than doubled from 2008 to 2015, and more than three-quarters of these doctors have certified EHRs. Prescribing errors have decreased, provider and patient access to clinical information has improved, readmission rates have fallen, and — perhaps coincidentally — health care cost growth has been at its lowest level in decades.

    Unfortunately, even though EHRs have proliferated, we have yet to achieve the interoperability, usability, and full utility of them. Part of that is due to a compliance mindset on the part of many vendors and providers who "check the box" to comply with the letter of the law, but fail to embrace the spirit of the law. The result has been EHRs that work in the lab, but not in the field, and practices that focus on fee-for-service billing while bemoaning software systems that slow them down. But there is a new driver of change in the healthcare system that is far more compelling than mere compliance with meaningful use regulations.

    At Aledade, for instance, we work with more than 200 independent primary care practices who have committed to taking accountability for the total cost and quality of care of their patients. We interact with more than 50 different EHR systems and patients who use more than 400 different hospitals across 15 states. There are many ways in which the health IT infrastructure built in the past 8 years is pivotal to our ability to succeed in new value-based payment models, but I will highlight two key areas where more needs to be done to make true, functional interoperability a reality.

    First is the use of real-time hospital event notifications to improve care transition for patients. Many health information exchange organizations are finally beginning to deliver true value by leveraging simple admission, discharge and transfer messaging to help reduce readmissions. But too often, we find hospitals or health systems who refuse to share this basic information, or make it more difficult than necessary because they see that data as a "strategic asset" — in the words of one hospital executive — instead of as a central part of making interoperability work for patients.

    We try to work around these roadblocks — even digitizing faxes and "scraping" data from them, but this behavior is putting patients at risk. The Department of Health and Human Services should use new authority given to it in the 21st Century Cures Act signed into law last December to impose tough penalties on information blocking, and state and federal officials should look into these anti-competitive behaviors from an enforcement point of view.

    Second is the use of EHRs to reduce the burden of quality measurement. A decade ago, I led a federally-funded research project to show that data routinely collected as a part of delivering care could be used for automated reporting of quality measures. We now have EHRs on every desk, and collection of most of the data elements needed. But clinicians are increasingly frustrated with box-checking and EHR systems that can't produce reliable quality measures and that won't export standardized data to outside registries and quality reporting intermediaries.

    We need EHR vendors to hold themselves accountable for their customers' success in the full cycle and not just for the calculation of quality measures in the certification lab. They need to focus on producing successful workflows to efficiently capture key data, correct configuration and mapping in the back end, and standardization of the data payload when exporting data. Customers need to demand more from their technology partners, and my former colleagues at ONC need to use their new authorities to enforce the certification program in the field.

    These steps will help accelerate the transition to value as well as the new IT tools we see emerging. However, to fulfill the promise of value-based care, to get data flowing, and to make interoperability a reality, we will need a true partnership between all of those working in health care and health IT. We need developers to talk with doctors, doctors talking to regulators, and regulators listening and responding to them all. If we do that, I have no doubt that in HIMSS conferences to come, we will celebrate a smarter health care system powered by technology and, thus, delivering better care for less money.

    Farzad Mostashari, MD, the former head of the Office of the National Coordinator of Health IT at the Department of Health and Human Services, is the CEO and co-founder of Aledade, Inc

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    Last year, the American Health Information Management Association (AHIMA) found that, on average, 10 percent of a health organization’s patient records are duplicates. Why is this statistic so alarming?

    In addition to the risk of incomplete or inaccurate medical information, duplicate records contribute to adverse events, medical identity theft and revenue loss. A study published in the Journal of Patient Safety by John T. James, PhD, claims that the United States experiences 440,000 deaths a year due to preventable medical errors as a result of incomplete medical records, making it the nation’s third-leading cause of death.

    It also means that the number of patient records in your system does not match the actual number of patients you serve. This skews patient population health metrics, affecting treatment analytics and reimbursement.

    If this isn’t motivation enough for you, the Office of the National Coordinator for Health Information Technology (ONC) includes objectives for reducing duplicate records in its nationwide interoperability road map. This year, duplicate record rates are to be reduced to 2 percent, to 0.5 percent by 2020, and less than 0.1 percent by 2024.

    How it all adds up

    According to figures presented at the 2014 HIMSS Conference panel on “Patient Safety and Risk to Rising Healthcare Costs,” the average cost to reconcile a single pair of duplicate records is $1,000. What is the average cost of a medical malpractice lawsuit? How much of an impact will patient dissatisfaction and negative outcomes cost your bottom line?

    Otherwise preventable medical errors can be caused by missing health information or overlays that mingle multiple patients’ records together. Not only are duplicate records putting patients at risk, the results are impacting patient satisfaction and patient outcomes as well.

    As the industry shifts toward the value-based care model, patient outcomes are now directly tied to revenue. Duplicate records pose a dual threat to patient safety and reimbursement.

    With duplicate records, you cannot know your true patient population or accurately assess treatments. Results are skewed. Information is fragmented. Repetitive tests are ordered. Care costs go up. Without accurate data, your organization could be missing critical population information that can cost you greatly.

    One record per patient

    It’s not just a matter of being more diligent with patient intake processes. To remove the possibility for the creation of duplicate records, an organization must implement a unique health safety identifier (UHSI)—a secure one patient, one record model.

    The ONC released its “Patient Identification and Matching Final Report” in February 2014, with findings that further illustrate the need for a UHSI. The report states, “The [patient identifying] attributes are generally highly variable from an implementation standpoint, with few fields being required, and little to no standardization of the data attributes themselves.”

    This problem was previously acknowledged by the World Health Organization (WHO) in 2007. Its report on patient identification, created in collaboration with the Joint Commission and Joint Commission International, proposed the standardization of patient identity verification and suggested the use of biometric technologies.

    Without an efficient way to identify and match patients with records, we cannot eliminate the creation of duplicate records. This problem also hinders interoperability efforts. If there is no standardization, the transfer of data is practically useless. Providers need complete health data to determine appropriate treatment as well as complete and accurate identification data.

    Starting a national conversation

    A petition was posted last spring calling for the development of a voluntary UHSI, as part of the AHIMA MyHealthID advocacy campaign. While the campaign’s intention was to educate consumers and decision-makers, the petition’s stated mission was to “Remove the federal budget ban that prohibits the U.S. Department of Health and Human Services (HHS) from participating in efforts to find a patient identification solution.”

    The petition did not reach its goal of 100,000 signatures, but it did succeed at starting the conversation about finding a solution. While the uncertainty of health reform on the horizon, health IT organizations are seizing this opportunity to resolve the issues themselves.

    Health IT and UHSI for better outcomes

    The implementation of a UHSI can solve the problems of duplicate records and misidentification, but it also holds promise for so much more. The UHSI model is being used in comprehensive patient identity solutions to tie the UHSI to insurance and payment information, thereby decreasing payment cycles and claim errors.

    By streamlining patient intake, identification and payment processes, patient identity solutions could enable greater clarity and engagement between providers and patients. These benefits have the potential to improve the overall patient experience, which is second only to improved data accuracy for appropriate treatment and better outcomes. That accomplishment will be a huge victory for enhanced quality care that will greatly benefit both patients and their health providers once implemented. 

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    When a hospital implements a new electronic health record system, there's no shortage of challenges to grapple with as the years wear on and the costs pile up.

    Chief among them is the fact that, as the new system is being rolled out piece by piece, existing applications still have to keep in working order to maintain operational support and care delivery. That juggling act demands smart staffing strategies – not just for the IT teams getting the new infrastructure up and running, but for those professionals dedicated to supporting and maintaining the older core systems.

    Houston Methodist took several years to replace its best-of-breed clinical applications with an integrated EHR. At HIMSS17, leaders from the health system will explain how they managed the challenge, offering their perspectives on the staffing pitfalls for a project of such size and scope, suggesting principles for maintaining employee satisfaction, giving tips on leadership strategies and on balancing the needs of employees and contractors alike.

    As an academic medical center with seven hospitals, a large physician practice, a research institute and a comprehensive residency program, Houston Methodist has a "fairly large" IT staff of 540 employees, said Penny Black, director, EHR & perioperative at Houston Methodist Hospital.

    All those employees had to be considered when, three years ago, the system decided to replace most of its best-of-breed apps with an integrated clinical system.

    "We had independent periop, anesthesia, pharmacy, EHR radiology – many of them have been consolidated by the integrated model," said Black. "Cardiology also, to some extent. One application we did not integrate would be the lab, but that pretty much covers the clinical systems."

    Right away, it was apparent that openness from leadership would be a lodestar for the duration of the multiyear project, she said: "Communication, transparency, managing employee resources and our consulting colleagues is really important, no matter what the project."
     
    Alan Perkins, associate principal with the Chartis Group, brought his expertise in  organizational change management and process design to bear on the initiative, and now also serves as associate VP for clinical informatics at Houston Methodist.

    "There are really three key risks that this organization – or any organization that's undertaking   a large-scale, enterprise IT-enabled project – needs to take into account," said Perkins.

    "The first is that if the majority of the existing IT resources are going to be dedicated to the new initiative, as they often are, the risk is that the quality of the legacy operating environment – and we're calling that core clinical – could decline," he said. "That could negatively affect adherence to regulatory requirements and key operational performance initiatives. That's one risk we sought to mitigate here."

    The second risk," said Perkins, is that if staffers assigned to the new implementation retain their operational responsibilities but then are also periodically pulled in to address operational issues, progress on the rollout could be adversely affected.

    "The third risk is to the IT leadership team," said Perkins. "If they're being asked to do both, that could significantly increase their workload. Trying to attend to both a large-scale implementation and existing operational responsibility could cause issues."

    Black says a key part of the rollout planning was recruiting the tech professionals who would serve on the implementation team: "That was a combination of folks both from IT and from operations," she said, and once the team was put together, its members were single-minded in their new task, working apart from their "old operations, jobs, positions and colleagues."

    At HIMSS17, Black and Perkins will share some of those org charts and explain how they managed the challenges and opportunities of the new staffing situation. "At one time we had more than 60 team members on the EHR team, and then one day, just five days after an upgrade, it shrunk down to 28 members," said Black. "We supplemented the existing legacy teams with consultant colleagues to help keep things running smoothly."

    Perkins recommends that hospitals make use of two dedicated but symbiotic deployment support teams: "One team that's primarily or exclusively focused on the new initiative, another that's primarily or exclusively focused on existing operational support," he said. "These teams (should) operate in a manner that is both independent and interdependent."

    Adding new leadership, contract workers to the mix
    "Another example of what was unique about our project is that we not only supplemented our analyst level resources, we supplemented leadership," said Black. "One of the risks of trying to manage a large-scale implementation and manage existing applications would be over-stretching those resources. So we brought in consulting managers, directors and even up to the vice president level to supplement our legacy team."

    Hospitals should look at these supplemental leaders not merely caretakers, but as people actively entrusted with advancing the strategic goals of the organization, said Perkins. "They may be in their roles for a year, maybe two years, even three years. And so it's important that they be able to hit the ground running – that they be experienced leaders, that they have a proven track record of success. And when you're bringing them in, you're bringing them in specifically to carry forward the strategic goals of the organization, not just keep the lights on."

    That can be easier said than done, of course: "When you bring in interim leadership, as in this case, there are several key decisions that need to be made," said Perkins. "One is you have to define how HR related responsibilities are going to be divided between your permanent staff and your interim leadership, you have to clearly define who retains financial authority – how are you going to handle things such as approval of invoices or budgeting.

    "And then you need to talk about how your interim leaders are going to function really seamlessly as part of the team," he added. "Because again, if you're bringing them in not merely as caretakers but as key leaders in the organization for a period of years, you need to make sure they are able to function effectively in their roles."

    Given that projects such as these demand the use of both employees and contractors, Black also has some simple advice for building them into a cohesive unit: "Include them."

    For the 18 months or so of the implementation, "our consultants were on-site," she explained. "We included them in our operations meetings, in our team events, in our dinners and outings. We treated them like they were part of the team. And in fact many of them – this started in 2014 – are still with us today."

    An overarching principle, of course, must be sound change management principle, said Black: "People adapt differently to change. Some of the folks who went over to the implementation team suddenly had new offices, new applications, new managers, new colleagues. Everything changed for them.

    "Not everyone handles change equally," she added. "We worked to be transparent and provide good communication for the legacy team. In fact, we stayed away from words like 'legacy.' We called the home team the core" clinical team, and actually engaged them and made sure they understood there would be a place for them."

    Perkins echoed the sentiment that communication is key. 

    "It enhances transparency and trust. So it's important to develop a communication plan, cross-team communication mechanisms – employee meetings, newsletters, special events – and that these communication venues emphasize the inclusiveness of the entire IT team," Perkins said. "And especially the significance of the support team's role in the organization. When that's done well and consistently, that communication will help to build trust and reduce any anxiety that might be felt by the team."

    Perkins added that Houston Methodist had an entire team dedicated to change management, another focused on program management, a third dedicated to communication, and a specialty testing team.

    "Part of that was being very transparent, specifically with regard to the staffing roadmap," said Perkins. "We're explicit from the very beginning about where we're going with staffing, we're communicating the process and the end state, so people have a very clear goal and a very clear view of where they are now, where they're going to be at the end, and what the process is going to be to get from here to there."

    Penny Black and Alan Perkins will present "Managing a Legacy Team in an EHR Transition" at HIMSS17, Feb. 21 from 8:30-09:30 a.m. in Tangerine Ballroom, F3 at the Orange County Convention Center in Orlando.

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


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    Healthcare providers use mobile devices to stay connected, access information, and enter data in real time, but no on device does it all. Device convergence solutions enable multiple functions on one device, improving workflows and minimizing risks to patients caused by loss of connectivity.

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    Children's National Health System will roll out Millennium Revenue Cycle, a Cerner suite of RCM technology that will be integrated with the health system's existing Cerner EHR and scheduling platform.

    Children's National includes a 313-bed hospital with more than 50 outpatient facilities.

    "Incorporating financial data with our clinical systems, all on the same platform, makes sense and provides an integrated billing, analytics and decision support experience," said Brian Jacobs, MD, vice president, CMIO and CIO at Children's National, in a statement.

    Children's National and Cerner began working together in 2005 with the implementation of the Cerner Millennium EHR. In September 2013, Children's National and Cerner partnered to establish The Bear Institute, the first pediatric health IT institute.

    [Also: Children's National Health System teams up with Cerner on quality measure dashboards to transform pediatric care]

    "Our innovative relationship with Children's National through The Bear Institute offers us a unique opportunity to work toward improved delivery of care for the industry," Cerner President Zane Burke, said in a statement.

    Since its founding, The Bear Institute has resulted in health technology innovations such as the highly visible Quality Boards throughout the hospital that display near real-time quality and safety indicators based on patient information.

    Twitter: @Bernie_HITN
    Email the writer: bernie.monegain@himssmedia.com


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    HIMSS Analytics' newest Essentials Brief offers a look back at health IT market trends in 2016 – and ahead to the rest of this year and beyond, projecting purchasing demand for 81 different applications in 2017 and 2018.

    In examining areas such analytics, telehealth, precision medicine and population health, the aim is to gauge hospital technology needs in the next 12 to 24 months, said HIMSS Analytics Director of Research, Brendan FitzGerald.

    "Given everything that's occurred from an adoption standpoint since 2008 and 2009, where are organizations going?" he said. "Where do they still need IT help to deliver on their vision?"

    The 2016 Year in Review & 2017 through 2018 HIT Demand Forecasts Study is a bit different than the usual HIMSS Analytics reports, said Fitzgerald – broader-based and more forward looking.

    "We have, statistically, analyzed historical demand and adoption," he said. "We've essentially added to that our algorithm for forward-looking predictive adoption, and basically come up with the next 24 months of where 81 different applications will be from a hospital adoption perspective."

    Among the in-demand technologies on hospitals' radar screens over the next two years, HIMSS Analytics sees certain trend lines emerging among particular categories of application type.

    1. Precision medicine. A smallish number of respondents (29 percent) to HIMSS Analytics' survey said they're pursuing precision medicine initiatives – understandable, given the capital expense, technology infrastructure and clinical expertise necessary to make the most of genomics. But the report says precision med will be a "primary topic of interest across the industry in 2017" and beyond as health systems seek to bring tailored treatments to their patients.

    2. Telemedicine. Long underutilized, telemedicine appears to be on an uptick: purchase of applications increased about 3.5 percent from 2015 to 2016.  HIMSS finds long-distance care evolving beyond the more obvious uses of serving the underserved, with the technology increasingly being leveraged for broader patient engagement initiatives, population health projects and ACOs. More organizations are also launching specialized virtual care facilities equipped with telemedicine tools.

    3. Security. Biometric technology is "slowly gaining momentum" as a means to enable security, according the report. While now mainly used for medication dispensing and employee ID, HIMSS Analytics expects other uses to proliferate over the next couple years, as it's applied to patient records and other data sources.

    4. Outpatient practice management and EHR. Ambulatory sites still lag hospitals when it comes to electronic health record ubiquity, but they're getting pretty close to universal adoption, with HIMSS Analytics showing that 92 percent of hospital-owned practices have EHRs, along with 78 percent of independent practices. Still, "activity in this market has not slowed," according to the report. That's mainly a function of additional regulations – MACRA, most notably – that call on providers to improving their clinical practice or face penalties. Practices are keeping these technologies top of mind as they try to survive in a value-based world, and should continue to in the years ahead.

    5. Revenue cycle management. The market for denials management tools is set for a flurry of activity in 2017 and 2018. While billing, collections and EDI have been commonplace at hospitals (90 percent market penetration) for years, just 44 percent of respondents told HIMSS Analytics that they use denial management technology. "Significant green space exists" for those and similar tools, given the attenuated care-to-payment ratio across the industry, according to the report.

    6. Population health. Population health management programs are becoming de rigeur, with 76 percent of respondents in 2016 saying they have them in place, compared to 67 percent in 2015. But there's still a lot to do to make sure they're sustainable, and able to improve outcomes on a wide scale. That leaves plenty of room for analytics vendors to make themselves heard in a busy market.

    7. Clinical and business intelligence. Somewhat surprisingly, just 41 percent of respondents said they make use of clinical and business intelligence tools for their analytics. But the steady proliferation of data across healthcare – and its potential to drive pop health, precision medicine and value-based care initiatives, that number is sure to be on the uptick in the next two years.

    Twitter: @MikeMiliardHITN
    Email the writer: mike.miliard@himssmedia.com


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    Six years after its first pilot projects were announced in 2011, Direct messaging could be reaching critical mass. Transactions increased 146 percent during 2016, according to a new DirectTrust report, which also sees a marked increase in the number of Direct Exchange addresses and users.

    There were more than 98 million Direct message transactions between Direct addresses in 2016, according to DirectTrust, a non-profit group representing participants in the interoperability network. There were more than more than 33.5 million Direct messages transmitted during the fourth quarter of 2016 alone. That brings the total number of transactions since 2013 to more than 165 million since 2013 (the year Direct Trust was founded).

    [Also: DirectTrust to Trump: Heed these 4 pieces of EHR interoperability advice]

    The number of trusted Direct addresses able to share personal health information across the DirectTrust network increased 24 percent, to more than 1.36 million since the end of 2015, according to the report. And the number of healthcare providers served by DirectTrust accredited health information service providers increased 36 percent – to nearly 71,000. That compares o just 52,000 at the end of 2015.

    DirectTrust's national network now includes 41 EHNAC-DirectTrust accredited HISPs working with more than 350 ONC certified EHRs, according to the group.

    "What we're experiencing is the continued expansion of Direct as a national platform for interoperability among users of hundreds of different vendors' EHR, PHR and other IT products," said DirectTrust President and CEO David. C. Kibbe, MD. "As EHRs become virtually ubiquitous in hospitals and medical practices, Direct messaging adds value by virtue of being 'plugged in' and able to replace fax and mail for all sorts of transactions, without the end user having to leave his or her EHR system. It's important that Direct be convenient and work flow friendly."

    [Also: Direct messaging finding stride, despite hurdles]

    According to a 2015 survey by the HIMSS Interoperability and HIE Committees, the biggest benefits of the tool – according to the hospitals, physician practices, HIEs, HISPs and ACOs polled – included speedier access to information, less paper handing and more accurate and complete patient information.

    The top five reported uses of Direct were: transitions of care; ADT notifications; patient communication; secure email for other purposes and consult requests between physicians.

    "The primary use cases for Direct continue to be support of care coordination, and clinical messaging for referrals and alerts, but we're also starting to see Direct messaging for administrative and research data communications," said Kibbe. "As demand for Direct grows, vendors are increasingly improving their usability for Direct, and adding file formats that can be shared as attachments. I am really encouraged to see those 'last mile' types of problems being addressed across the entire industry."

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    It’s only one piece of several other displays, demonstrations and discussions happening inside the 110x100 square-foot Epic Systems booth at HIMSS17, but “Make More Money with Epic” seems primed to draw a crowd.

    “We’ll be sharing how folks are improving their operating margin and showing the value that people are achieving using Epic,” said company spokeswoman Erika Koch, who is a designer and part of the events team.

    Epic puts forth examples. One is the University of Colorado Health, which doubled its margins within one year after installing Epic, and sustains the high margins with laser focus on revenue capture, and continues to maintain that higher level today, seven years later.

    Koch noted there will be several other stations within the booth where guests can learn about Epic software and the unique ways clients are putting it to use in their health systems.

    “There are different stations, where folks can go around and see different areas as well as our customer community – successes they are experiencing on the Epic platform,” Koch said. “There will be opportunities to see how Epic clients are putting the software to work for them.”

    Epic will also highlight the patient engagement technology it is developing.

    “We’ll be talking about how we’re making our software a joy to use,” Koch said, “and about our physician community and how we’re hoping to improve physician efficiency – as well as highlighting our peer group."

    There will be demonstrations offered for people who want them, and opportunities to ask questions and for customers to meet other customers.

    “All of our developers come to this, and all of our software, of course,” Koch noted.

    CEO Judy Faulkner and the Epic crew will also ship pieces of their Wisconsin campus to HIMSS17. The paintings and sculptures – different ones each year – lend the booth a dash of whimsy that is evident inside and outside Epic’s corporate headquarters at 1979 Milky Way, Verona, Wis. The eclectic pieces give the booth the Epic feel.

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center. 


    This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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    It’s a story healthcare has heard before: Hospital installs expensive electronic health records software, must rein in spending to avoid hefty losses. For California’s John Muir Health, that meant a comprehensive review of their information technology expenses that ended up saving them big on total IT costs.

    “We made sure our IT spend wasn’t completely out of line by looking at other facilities,” said Christian Pass, chief financial officer at John Muir.

    Pass enlisted consultancy The Chartis Group to help with that work.

    “The consultant looked at our numbers, they looked at what some of the drivers to the expenses were and really helped us think through what was the best way to use our IT dollars,” he said.

    While scrutinizing IT spending, for instance, officials ended up confronting a question over how they would manage the disaster recovery system for their EHR.

    “We were going to buy the system hardware and let someone else host it, but we discovered that it was less expensive and created a better service by going down an SaaS path,” he said.

    The process also led John Muir to change operating systems for its EHR after discovering that the IBM framework it was using was slightly more expensive than other options. The system instead switched to X86 machines, Pass said.

    By working with the consultant to scrutinize its IT spend since 2015, John Muir cut $5 million in costs, an 8 percent reduction.

    “The exercise was really geared toward finding efficiencies,” he said. “Knowing that we had to run Epic, knowing that we had to have off-site recovery, we really set out to find the best way.”

    Pass, who plans to speak more about his system’s experience during a panel discussion at the HIMSS17 conference in Orlando in February, said there a few essential controls needed to be able to effectively manage costs.

    First is a strong governance culture, highlighted by a collaborative spirit among all C-suite titles at the operation. From his perspective, that means the CFO and the chief information officer need to work as one.

    But the other control needed is a strong value in understanding the demand of systems, which means making sure you really grasp what’s good enough and what their existing technology allows for before investing in new elements.

    “By adding additional systems we create burden, friction and expense,” Pass said. “So we are really trying first to look at what’s available and how we leverage that versus going out and buying a shiny new toy.”

    Pass and Chartis Group associate principal Greg McGovern will present the session, “Benchmarking, IT cost controls and efficiencies,” on Wednesday, Feb. 22 at 1-2 p.m. EST in Room W307A.

    HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center. 


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    With healthcare organizations managing hundreds of applications on myriad platforms within their enterprise, streamlining IT management is critical. With on- and off-premise resources needing to be balanced, a managed hybrid cloud - hosted private cloud - can be leveraged to best support application workloads.

     

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