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    New technologies in consumer markets (travel, shopping, social/networking with friends, etc…) are continually drawing in people, creating new demand curves, while healthcare – with its faxes, beepers, legacy system software – remains comfortably and obstinately entrenched in its frozen time bubble. In short, we haven't seen any 'break all the laws' bids in healthcare – like what Uber did with ride sharing or Amazon for shopping. 

    That said, I'm an optimist. Despite the glacial-like pace of groundbreaking health information technology to date, I predict that in 4 to 6 years we'll see an explosion of networked-backed health services that come with a loyal commitment and proven ability to chip away at our industry's massive cost overrun and inefficiency issues. If they're going to stick, however, they'll need the right adoption incentives and network from which to grow. 

    Back in the day, health IT vendors were king if they could convince potential buyers that they had mastered the meaningful use game. With MACRA and MIPS, not much has changed; vendors still remain on the hook for helping provider organizations report against government programs. This is the easy stuff, as evidenced by the massive glut of government certified solutions.

    But as reimbursement models, both public and private, shift to demand quality beyond just reporting, so too does the job of health IT. I find it satisfying that the playing field will no longer be defined just by "check the regulatory box" systems, but will become an arms race to determine which health IT partners will play the most meaningful role in driving actual performance. A definite sorting of the wheat from chaff. 

    As such, it's time for health IT buyers to start the arms race, to demand a new set of core competencies from health IT systems and the vendors who sell them that work in service to the organizations that use them. Some of the most successful companies in their respective industries like Waze, Google and Kayak, tap into the power of networks to deliver valued results to their users. Shouldn't health IT systems follow suit?

    If healthcare operated off of a networked infrastructure, data would be stored holistically, rather than trapped in silos at individual organizations. Data could be viewed comparatively so insight into clinical, financial, and operational performance is not limited to a single site, but could be benchmarked across an entire network of peers. Bright spots could be found. Best practices identified. Inefficiencies corrected at scale.

    Data put to use in this way means greater connectedness to care happening outside a health system, too. Transparency like this would mean better planning against priorities such as keeping schedules full; providing value to affiliated groups; managing at-risk populations; and gaining better visibility into the behaviors of providers across multiple medical groups and systems.

    The brilliance of "the network" is that it sits on an open API-enabled platform from which innovation can not only be introduced, but can be introduced quickly and broadly. Legacy servers in basements (software) can't do this. Just as downloading a "must-have" app from the app store is second nature, health organizations should be able to shop for the best solutions to plug into their EHR and practice management service – and be up and running in quick order.

    With networked healthcare, access to the latest innovation becomes the norm – from the 400-bed academic medical center seeking to cut costs by integrating telepharmacy tools to the suburban three-doc practice looking to maximize clinical staff time with digital check-in.

    Stop tolerating what you have. If your system, your software, doesn't drive clinical and financial performance, demand that it does. If your vendor doesn't coach you to perform, or doesn't have a business model that hinges on you doing well, ask why. The shine of being government-certified is wearing off, and the days of implementing health IT systems to collect a subsidy are over.

    Health IT needs to jumpstart smarter, better and more efficient healthcare – which in my humble estimation – can only happen when purchasers demand change and embrace a networked platform. To compete, you should be asking more of your system as success more than ever isn't about being digital, it's about setting out a path for performance. 


    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

    Specific Terms: 

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    Many tech titans and innovative upstarts are trying to solve the existing health data interoperability problem and to make data secure, transportable and actionable. Allscripts is among those.

    In an interview ahead of HIMSS17, Healthcare IT News asked Allscripts CEO Paul Black about maintaining relevancy in a maturing EHR market, how the company is working to make its architecture a platform for third-party innovation and about what Black described as "a brilliant solution for interoperability."

    Q: A lot is happening in the EHR market, and some analysts would say it's starting to look like a three-way race between Cerner, Epic and Meditech. So what is Allscripts doing to stay relevant in the maturing EHR fray?
    A:
    We're in a much better position than we were five years ago, because of the investments we made organically to build out our product suite Sunrise. I feel good about what we’ve done to fill in some of the capabilities that in the past were not there but are today. When people get a refresh on Allscripts of what we had in 2012 versus what we have today, that draws a lot of, "Wow, I didn’t you know had this," or "I didn’t know you had that."

    Q: Can you give some specific examples?
    A:
    Our approach to open is a lot different than other approaches to open. We publish APIs. A lot of companies will do CCDAs but we open our system up at the API level and that’s a big deal. You have to be certified to do that. We have also created an innovation platform and we encourage people to develop tools that are consumer-based or financially-based that allow apps to sit on top of our platform and innovate on top of it. We now have 5,000 people certified to develop on top of an Allscripts platform. Since 2013 we’ve had 2 billion API data exchanges. So when you ask, "Is it working?," or "Is it interesting?" when people talk about open our definition has to do with being vendor agnostic and we allow a very deep level of integration. I want people creating an ecosystem that I’m the center of, of course, from which I encourage people to pull information out so they can take better care of their patients. There’s a group of people inside our company whose sole job is to help startups. It’s a sizable piece of our organization and we have a chief innovation officer. Now with everything being digital the frustration that will continue in the marketplace is not being able to have pure liquidification of data across all electronic medical records — there will be a market need for that interoperability, which we think we have an extraordinarily brilliant answer for.

    Q: Alright, I’ll bite: You said you have a brilliant solution for interoperability. What might that be?
    A:
    We have a solution in place within our CareInMotion suite called dbMotion. It is an EMR-agnostic approach to pulling data out of multiple electronic medical records, meaning athena, Cerner, Epic, Meditech, eClinicalWorks, NextGen and putting that data into a single community record. We then can pull in information from insurance companies or a health exchange and the third thing I can pull in is genomic information. So our dbMotion platform is an approach to give a single view of the patient that has multiple different records subsystems. That data then can be analyzed to identify populations that look like me, people who have the same three conditions I have, how they respond to treatment and, more importantly, it sends that information back into the other medical records so the clinicians, primary care and specialists, all have a protocol they can follow when I show up.

    For the workflow component, the way we do it is different. A lot of people have interoperability platforms to pull the data up into an HIE. That’s good but once the data are there you want to make it actionable and the ‘ah ha’ moment is when you can then send it back down into the original sending electronic medical record and you have to do that workflow in a way that is non-invasive. So the clinician looking at the record only gets the new information about me and no, "Click on this HIE and get everything about Paul Black since the day I was born." Practicing busy clinicians want to know if there is anything else in the community that they don’t already know, like a prescription, allergy or med I’ve been given. That workflow is the clever piece of what we do that is different than anything else I’ve seen.

    Q: Some people would apply the buzzword "post-EHR" era to that scenario you just described …
    A:
    I would say that buzzword is the reality of living in a digital platform. The U.S. broadly — whether its 92, 94 or 98 percent, whatever the numbers ONC publishes — every doctor and hospital has an electronic medical record. The platform is digitized and this is a fascinating time to be alive because it’s the first time in the history of this country that all these data are now digital, available, and the people who make the most use of that and turn it into something actionable clinically, financially and from a research standpoint, are going to win. It’s going to be extremely important for us to, instead of saying, "That was great we’re done," and sitting back in a rocking chair, now it's, "Holy moly, we have all of this data what are we going to do with it? And how do we use all this data to drive more efficient, effective care that produces better outcomes for people who have serious issues?"

    Q: What’s next for Allscripts? And the healthcare industry at large?
    A:
    I think we’ll see continued adoption of some the things we’re doing in the States in other countries. Other countries have been waiting but there is going to be an effect of mass digitization. We’ll see other nations undertaking large IT projects at scale; there will be a global focus on this, either organization by organization or ministry of health by ministry of health. Secondly, I think all the data that is a byproduct of the mass digitization will be a boon for analytics, will be a boon for having a much better feel for the ins and outs of the operational side of healthcare as well as the clinical side. And I believe there will be price-performance that leads to mass adoption of genomic testing. And then having diagnostics, based on data, come out of an EMR to clinicians so they can order the test, get the results back in the EMR and know how to personalize care regimens. If I look out 10 years, we’ll be surprised and shocked at how quickly these things become commonplace. 


    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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    Epic landed the top spot for Overall Software Suite in the 2017 Best in KLAS: Software and Services report, for the seventh consecutive year. The report draws from healthcare provider feedback.

    Epic also earned the top Overall Physician Practice Vendor and Best in KLAS awards in eight segments.

    Premier scored four Best in KLAS awards and won Overall Best in KLAS for Healthcare Management Consulting Firm, a new category. Optimum Healthcare IT was named top Overall IT Services Firm and earned one Best in KLAS award.

    Cerner, Caretech Solutions, MedSys Group and IBM Watson subsidiary Merge each earned two Best in KLAS awards.

    Verity Solutions' Verity 340B was the most improved software product with an increased score of 17 percent, while Peak Health Solutions’ Peak Outsourced Coding was named the most improved service product with 21 added percentage points. The most improved physician practice product with an increase of 12 percent was NextGen Healthcare EPM.

    For the first time, KLAS added Payer Solutions segments. Casenet TruCare was Best in KLAS for Case Management Solutions and Verscend Quality Reporting was Best in KLAS for Payer Quality Analytics and Reporting.

    "The Best in KLAS report celebrates and recognizes vendors who have made significant strides to improve healthcare while addressing changes like payment reform and the shift to population health," said KLAS President Adam Gale in a statement.

    Here’s the complete list of winners:

    Best in KLAS: Software

    Category Recipient
    Acute Care EMR (Large Hospital/IDN) Epic EpicCare Inpatient EMR
    Anesthesia iProcedures iPro Anesthesia
    Cardiology Merge, an IBM Company, Cardio
    Community HIS MEDITECH C/S Community HIS (6.x)
    Emergency Department Wellsoft EDIS
    Enterprise Resource Planning (ERP) Premier PremierConnect ERP Solutions
    Global (Non-US) Acute Care EMR InterSystems TrakCare EPR
    Global (Non-US) PACS Sectra PACS
    Global (Non-US) Patient Administration Systems InterSystems TrakCare PAS
    Health Information Exchange (HIE) Epic Care Everywhere
    Healthcare Business Intelligence & Analytics Health Catalyst Analytics Platform
    Homecare Thornberry NDoc
    Laboratory (Large Hospital/IDN) Epic Beaker
    Long-Term Care MatrixCare
    PACS (Large Hospital/IDN) Sectra PACS
    Patient Access Experian Health eCare NEXT
    Patient Accounting & Patient Management (Large Hospital/IDN) Epic Resolute Hospital Billing
    Patient Portals Epic MyChart
    Population Health Enli CareManager i2i Population Health i2iTracks
    Speech Recognition—Front-End MModal Fluency Direct
    Surgery Management Cerner Surgical Management
    VNA/Image Archive Merge, an IBM Company, iConnect Enterprise Archive

    BEST IN KLAS: Physician Practice

    Category Recipient
    Ambulatory EMR (Over 75 Physicians) Epic EpicCare Ambulatory EMR
    Ambulatory EMR (11-75 Physicians) Epic EpicCare Ambulatory EMR
    Small Practice Ambulatory EMR/PM (<10 Physicians) CureMD EMR/PM
    Practice Management (Over 75 Physicians) Epic Resolute/Prelude/Cadence Ambulatory
    Practice Management (11-75 Physicians) athenahealth athenaCollector
    Claims and Clearinghouse Navicure ClaimFlow

    BEST IN KLAS: Payer Solutions

    Category Recipient
    Care Management Solutions (Payer) Casenet TruCare
    Payer Quality Analytics and Reporting Verscend Quality Reporting

    BEST IN KLAS: Professional Services

    Category Recipient
    Application Hosting Cerner
    Cybersecurity Advisory Services CynergisTek
    Extended Business Office PwC
    Extensive IT Outsourcing CareTech Solutions
    Financial Improvement Consulting Premier
    HIT Advisory Services MedSys Group
    HIT Enterprise Implementation Leadership Optimum Healthcare IT
    HIT Implementation Support & Staffing MedSys Group
    Partial IT Outsourcing CareTech Solutions CTG
    Strategy, Growth, and Consolidation Consulting Premier
    Technical Services Leidos Health
    Value-Based Care Consulting Premier
    Value-Based Care Managed Services Lumeris

    BEST IN KLAS: Software

    Category Recipient
    340B Management Systems Macro Helix 340B Architect
    Acute Care EMR (Community Hospital) Cerner Millennium PowerChart/CommunityWorks Clinicals
    Advanced Visualization Vital VitreaAdvanced
    Alarm Management Connexall
    Anatomic Pathology Cerner CoPathPlus
    Business Decision Support Strata Decision StrataJazz Decision Support
    Cardiology Hemodynamics Merge, an IBM Company, Hemo
    Chargemaster Management Craneware Chargemaster Toolkit
    Claims Management Experian Health ClaimSource
    Clinical Decision Support—Care Plans Elsevier Care Planning
    Clinical Decision Support—Order Sets Zynx Health ZynxOrder
    Clinical Decision Support—Point of Care Clinical Reference EBSCO Health DynaMed and DynaMed Plus
    Clinical Decision Support—Surveillance Wolters Kluwer Pharmacy OneSource Sentri7
    Clinical Documentation Improvement Software (CDI) ChartWise CDI
    Computer-Assisted Coding (CAC) Dolbey Fusion CAC
    Document Management & Imaging Hyland OnBase
    Image Exchange Ambra DG Suite (DICOM Grid)
    Infection Control and Monitoring BD MedMined
    Integration Engines Corepoint Health Integration Engine
    Interactive Patient Systems TVRC pCare
    IV Workflow Management MedKeeper PharmacyKeeper
    Labor and Delivery Philips IntelliSpace Perinatal
    Laboratory (Community Hospital/Ambulatory) Orchard Harvest LIS
    Medical Records Coding 3M Codefinder
    Mobile Charge Capture MedAptus Pro Charge Capture
    Oncology Elekta MOSAIQ
    Oncology Treatment Planning Varian Eclipse
    PACS (Community Hospital) INFINITT PACS McKesson Radiology
    PACS (Imaging Centers/Ambulatory) Sectra PACS
    Patient Accounting & Patient Management (Community Hospital) MEDITECH C/S Patient Accounting
    Patient Flow TeleTracking Capacity Management Suite
    Patient Outreach Talksoft Patient Engagement Messaging Suite
    Patient Privacy Monitoring Iatric Systems Security Audit Manager
    Quality Management Nuance Clintegrity Quality Management Solutions
    Real-Time Location Systems (RTLS) CenTrak RTLS
    Retail Pharmacy—Outpatient Epic Willow Ambulatory
    Scheduling—Nurse and Staff GE Healthcare Centricity ShiftSelect (API)
    Scheduling—Physician Lightning Bolt Scheduling
    Secure Communications Platform Voalte One & Voalte Me
    Single Sign-On HealthCast eXactACCESS/QwickACCESS
    Speech Recognition—Front End Imaging Nuance PowerScribe 360
    Speech Recognition—Back End MModal Fluency for Transcription
    Standard Secure Messaging Doc Halo
    Talent Management Halogen Software ​TalentSpace for Healthcare
    Time and Attendance GE Healthcare Centricity Time and Attendance (API)
    Urgent Care Practice Velocity VelociDoc Tablet Urgent Care
    Universal Image Viewer Agfa HealthCare Enterprise Imaging XERO Viewer

    Category Leaders: Payer Solutions

    Category Recipient
    Payer Claims and Administration Platforms TriZetto Core Claims/Administration Solutions

    Category Leaders: Services

    Category Recipient
    Business Solutions Implementation Services PwC
    Clinical Documentation Improvement (CDI) Services PwC
    Clinical Optimization Impact Advisors
    Go-Live Support Optimum Healthcare IT
    Outsourced Coding Peak
    Release of Information MRO Corp
    Revenue Cycle Optimization Avaap (Falcon Consulting)
    Revenue Cycle Outsourcing Navigant Cymetrix
    Transcription Services nThrive Precyse

    Best in KLAS: Global Software (Non-US)

    Category Recipient
    Global (Non-US) Patient Administration Systems InterSystems TrakCare PAS
    Global (Non-US) Acute Care EMR InterSystems TrakCare EPR
    Global (Non-US) PACS Sectra PACS

    Regional Category Leaders

    Category Recipient
    Global Acute Care EMR - Asia/Oceania InterSystems TrakCare EPR
    Global Acute Care EMR - Canada MEDITECH Enterprise Medical Record 6.x
    Global Acute Care EMR - Europe Epic EpicCare Inpatient EMR
    Global Acute Care EMR - Latin America MV SOUL MV
    Global Acute Care EMR - Middle East InterSystems TrakCare EPR
    Global Patient Administration Systems - Asia/Oceania InterSystems TrakCare PAS
    Global Patient Administration Systems - Europe Cerner Millennium PAS
    Global Patient Administration Systems - Latin America Philips Tasy PAS
    Global PACS - Asia/Oceania Carestream Vue PACS
    Global PACS - Canada Intelerad IntelePACS
    Global PACS - Europe Sectra PACS
    Global PACS - Latin America Fujifilm Synapse
    Global PACS - Middle East MILLENSYS Vision Tools Workspace
    Specific Terms: 

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    Children's Hospital of Pittsburgh of UPMC and Cincinnati Children's Hospital Medical Center have both recently been revalidated for Stage 7 status on the HIMSS Analytics Electronic Medical Record Adoption Model.

    Children's Hospital of Pittsburgh uses an integrated electronic medical record system – implemented way back in 2002 to store each patient's full medical history and care details. Over the years it has significantly reduced potential medical errors and streamlined processes, becoming one of the most technologically advanced children's hospitals in the nation, according to HIMSS.

    That commitment to state-of-the-art IT has led to a variety of innovations. Embedded clinical decision support tools in the EMR help enhance care quality and patient safety. The implementation of predictive analytics can forecast clinical deterioration in patients, enabling more timely interventions.

    And barcoding technology for positive patient identification helps ensure the so-called "five rights" of medication administration; the hospital even developed a barcode-based human milk tracking application for newborns in its Neonatal Intensive Care Unit, using barcode scanning.

    "Using analytics has reduced mean length of stay from 36 hours to 31 hours and remit rates have dropped from six percent to two percent," said Philip Bradley, regional director, North America, healthcare advisory services, operations, HIMSS Analytics, in a statement – adding that the hospital's analytics capabilities are helping physicians in performance review of pediatric appendicitis.

    "A strategic goal at Children's Hospital is quality improvement through automation and evidence based practice," said Srinivasan Suresh MD, its chief information officer and chief medical information officer, in a statement. "We aim to build and promote the use of advanced analytic dashboards to improve safety and quality in the care of our children, which also results in measurable cost savings."

    In Ohio, meanwhile, Cincinnati Children's kidney transplant team impressed HIMSS with innovative technology to improve medication adherence, a significant challenge for children with transplanted kidneys.

    The transplant team uses a pre-visit planning reporting tool that integrates data from multiple sources, including the EHR, according to HIMSS, including risk scoring, "smart" pillbox data which is created when a patient opens an electronic pillbox, and patient adherence questionnaires. That helps the team work with each patient to strategize and overcome adherence barriers.

    The results, so far, have been promising: 10,720 patient days between transplant rejections, when the previous best was 7,830, fewer rejected transplants and estimated savings of $680,000 in hospital charges.

    "Children's provided one of the most touching and impressive case studies related to pediatric kidney transplant patients," said Bradley. "They use their EHR to not only ensure the accuracy of care, but also, to outreach to the children and the family to ensure their patients follow the protocols."

    "The HIMSS Analytics Stage 7 validation affirms our continued passion for excellence," said Michael A. Fisher, president and CEO, Cincinnati Children's. "I'm grateful to our entire team who contributes to this effort every day, and excited about what their efforts mean to patient safety, quality care, research, and ultimately, the health of the children and families we serve."

    Both UPMC and Cincinnati Children's will be recognized at the 2017 HIMSS Conference & Exhibition on Feb. 19-23, at the Orange County Convention Center in Orlando, Fla.


    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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    Electronic health records have become an integral part of healthcare delivery over the past decade or so, and for the most part, providers have adapted to using them in varying capacities. Still, there is a sense in the industry that EHRs aren't fulfilling their enormous potential as conduits for personal health information, patient diagnostics and monitoring, point-of-care decision support and as an optimal financial tool.

    EHRs definitely need to be optimized, industry analysts say, but going about it brings forth some thorny issues regarding healthcare's changing business model, utilization protocols, definition of purpose and enriching the technical capabilities necessary to give them more functionality.

    As for why EHRs haven't yet become a pinnacle of success for the modern age, the menu of reasons is vast.

    Jon Melling, partner with Scottsdale, Arizona-based Pivot Point Consulting, can cite a multitude of reasons himself. The challenges are all over the map, ranging from regulatory difficulties to the business model transition to cost questions to confusion over the EHR's role in the organization.

    "My concern today and for a number of years now, is that the vendors are overloaded with federal and state mandates to keep abreast of, which creates a concern both on whether vendors can cope, and a major concern on whether providers can cope with it as well," Melling said.

    [Also: ONC releases EHR optimization guides for Million Hearts campaign]

    "There seems to be disconnect between timeframes being placed on them, which forces them into a situation where vendors have to find a way to make it work," he added. "For end users, optimization is a wish that the vendors could do more, but the only way seems to be a workaround. That is suboptimal and creates more work for end users."

    Likewise, healthcare's transition from fee-for-service to a value-based business model also presents challenges for EHR optimization, Melling said.

    "As we move to value-based reimbursement, we have a variety of venues to select, including value-based care and fee-for-value, which are incompatible in the system," he said. "FFS, which goes back to the diagnostic-related group policy in 1983, can have a code placed into the charge master to support the level of granularity and payers will cover it. But that is only a partial solution and not a lot is settled."

    'Concrete is poured'
    Complicating the EHR optimization question is the fact that "the concrete has already been poured" and the systems are in place, observed Dave Lareau, CEO of Chantilly, Virginia-based Medicomp Systems.

    "So now it doesn't matter how much more functionality there is if it isn't working with the systems," he said. "For those who have the ARRA money for the systems and weren't optimized for clinical users at the point of care, anything that is done now has to work with the existing systems and provide significant value that vendors can't provide on their own."

    Because of the current way EHRs are organized and deployed, healthcare providers are behind the curve, Lareau said. With the advent of analytics, precision medicine and big data, the EHR's limitations are exposed, though he added that more data doesn't equal the most relevant data.

    "There is lots of wisdom to be gained from that," he said. "The more data you give a clinician at the point of care is not always relevant to that moment – it's a tsunami of information that gets in the way and needs to be filtered better. You want the data points related to that one click."

    As a physician, Medicomp Chief Medical Officer Jay Anders, MD, says many in his profession share his frustration with the clinical limitations of EHRs. Accessing the most pertinent information at the point of care can be a labyrinth to navigate and often turns into an exercise in futility, he said.

    "EHRs tend to be big piles of data collection," Anders said. "The problem is that no one took into account how physicians actually do their work, so it doesn't fit what they do. It slows them down and makes them mad."

    Lareau adds: "The technology is in there, but the use of that technology is seen as an impediment rather than an enabler of what physicians do. Data has to be usable at the point of care and that is the real challenge."

    The original EHR design can be blamed for its un-intuitive method of furnishing information, Lareau said, because "their main purpose was for reimbursement – to get it over to billing." The clinician's purpose wasn't really taken into consideration, he said.

    Anders explained the source of the frustration by using an encounter with a diabetic patient as an example. Because diabetes has so many co-morbidities and elements, data from different sources needs to be accessed, typically from different silos in different places.

    "I have to click on six different places to see if the patient's renal condition is getting better or worse," Anders said. "What I need are the primary data points and I don't want to navigate through different places to get it. Show me what I need to know. Everyone thinks population health and big data will solve everything when I don't need that – I have a population of one in front of me, which is where I need to focus."

    Plugging gaps
    Chris Hobson, MD, CMO and chief privacy officer for Scottsdale, Arizona-based Orion Health, has a similar view to Anders' about how circuitous the access to relevant data can be for practicing physicians. From Hobson's perspective as a facilitator for health information exchanges and other health networks, EHRs tend to be static in their data function, so that they are reliant on other sources for the most pertinent, up-to-date information.

    Thus, Orion serves as a go-between entity that plugs gaps between the HIE and EHR through automated data feed and by utilizing clinical support staff to procure the most significant data for the physician.

    "We're well aware physicians are unhappy with the value they get from EMRs," Hobson said. "Clearly they've not been given all they hoped. So what do we do about it? Orion started integration to integrate data and web portals to see the data from multiple systems. We've done that with HIE, which gives clinicians a lot of value. Part of it is to replace and give functionality the client doesn't have."

    Orion is working to configure HIEs to collate and sort data by topic and chronology, with the most recent developments at the top. It is also assembling the system so it provides all relevant data in the most logical manner.

    "We are working on cracking the nut – we haven't quite cracked it yet, but we know what the nut is," he said.

    Twitter: @HealthITNews


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    In an effort to improve visibility into data security threats and help healthcare organizations manage security strategies with that knowledge, HITRUST has put together what it calls a Threat Catalogue, based on risk factors and controls of its Common Security Framework.

    HITRUST helps healthcare groups meet the HIPAA requirement to "conduct an accurate and thorough assessment of the potential risks and vulnerabilities" to its patient data. Its CSF framework is based on risk analyses performed by representative healthcare organizations and the underlying risk analyses used to produce ISO 27001 control recommendations, NIST SP 800-53 control baselines and other control-based frameworks.

    "HITRUST actively solicits industry input on potential changes and updates to the HITRUST CSF and, unlike other frameworks, updates the CSF no less than annually," said Bryan Cline, vice president, Standards and Analytics at HITRUST.

    The new threat catalogue takes the aim of the CSF "one step further," he said, enhancing the underlying risk analyses used to develop it and helping ensure the CSF and the CSF Assurance Program remain current and relevant. The catalogue aims to give better visibility to emerging threats and help CSF continue to address risk commensurate with various organizational, system and regulatory risk factors, officials said.

    "Most organizations do not possess the skill-sets necessary to truly identify ever changing cybersecurity threats and associate these threats with the operational impact, tactical response and strategic planning required," said Roy Mellinger, chief information security officer at Anthem and a governing chair of the HITRUST Working Group.

    The threat catalogue, he said, "takes the guess work out of the process. It articulates the threats, maps these to the necessary HITRUST CSF controls and provides organizations with a workable blueprint to define the protection mechanisms and strategies that are required."

    In addition to HIPAA risk analysis, the catalogue can also help with other types of analyses, according to HITRUST, such as the supplemental risk analyses used to tailor a control baseline to the unique needs of an individual organization, or more targeted risk assessments to evaluate alternate or compensating controls as well as formal risk acceptance.
     
    While the HITRUST Threat Catalogue will mature over time, officials said it will focus first on four areas:

    • Identifying and leveraging an existing threat taxonomy for common adversarial and non-adversarial threats to electronic protected health information;
    • Enumerating reasonably anticipated threats to ePHI for a general healthcare organization;
    • Mapping HITRUST CSF control requirements to those enumerated threats;
    • Identifying additional information needed in future iterations of the catalogue to help meet its objectives.

    A proliferation of threat and intelligence feeds and services, while valuable, has led to "information overload," said Kevin Charest, divisional senior vice president and CISO, at Health Care Service Corporation and a governing chair of the Working Group.

    "What I see in the HITRUST Threat Catalogue is the linkage and practical application that will lead organizations to take tactical actions that will enhance the overall security posture in response to the current threat environment."

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


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    Cerner President Zane Burke said the company is continuing to push forward with a focus on overarching trends such as patient identification, population health – and an open philosophy to interoperability.

    “It’s one thing to say it, it’s another thing to do it,” Burke said. “It takes significant focus to be both open and interoperable.”

    Cerner is dedicating a chunk of the $700 million it spends for research and development on advancing the open approach, Burke said, by working with partners and enabling them to develop on top of Cerner software via APIs.

    “I thought we took a major step with the announcement of CommonWell Health Alliance and Carequality,” Burke explained. “We’re going to do anything possible to move forward on interoperability. We view it as a moral obligation in our industry.”

    Cerner is also increasing its focus on population health. The goal is to keep the person “at the center of everything we do in healthcare,” Burke said.

    There are also significant investments going toward usability, revenue cycle management and population health.

    “Usability is a really key element,” he said. “We’re asking clinicians to do more and more.”

    Cerner is investing in revenue cycle across the entire continuum of care. And Burke sees a lot of promise.

    “We have big investments across the continuum of care in the EMR – so think behavioral health, long-term care, skilled nursing, rehab, surgery centers,” Burke said. “All the care side is to be automated and tied.”

    Cerner is at Booth 2161. 

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


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    The Prescription Monitoring Program of Virginia was awarded a $3.1 million grant from Perdue Pharma, a biopharmaceutical company.

    The funding will help integrate PMP data into provider and pharmacist clinical workflow, using NarxCare technology developed by Kentucky-based Appriss, which will connect the state's PMP to provider and pharmacy EHRs, officials said. Appriss operates Virginia's PMP.

    The integration is another step toward combating opioid addiction and overdose in the commonwealth.

    Providers and pharmacists can use the Virginia PMP database to check a patient's history for certain prescriptions reported both in-state and out-of-state pharmacies, officials said.

    The integration of PMP data with EHRs will make it easier to detect patients who shop for doctors to gain access to opioid prescriptions, officials said. And improve performance, access and usability of the PMP, which will contain the data of over 18,000 providers and 400 pharmacies in Virginia by the end of 2017.

    "The epidemic of opioid addiction is a public health emergency in Virginia, and combating it is a top priority for my administration," said Democratic Virginia Governor Terry McAuliffe in a statement. "The Prescription Monitoring Program is a critical prevention tool that helps curb abuse of prescription medications, and I applaud this enhancement that makes the PMP easier and more likely for physicians to use."

    "This upgrade of Virginia's prescription drug monitoring program will allow health providers and pharmacists to more effectively flag at-risk patients and curb prescription drug abuse as we fight against our commonwealth's opioid abuse epidemic," David Brown, Director of the Department of Health Professions.

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    The path to interoperability has been a circuitous one over the past 13 years, veering off in directions that weren't anticipated when the concept became an industry-wide initiative in 2004. So much has transpired, so many variables introduced and so many contingencies encountered that it is easy to lose track of the original intent and purpose of an interoperable architecture that spans the entire healthcare spectrum.

    Yet those directly involved in the advancement of interoperability say despite all the detours, the course remains straight ahead to achieving full-scale connection across all systems and entities in the healthcare continuum.

    Jon Elwell, CEO of Boise, Idaho-based Kno2, contends that the original integrity of the infrastructure remains intact, though it is not without hiccups in the system.

    "We have a fairly unique perspective because we get insights from end users and vendors across the continuum," he said. "Technology vendors will echo to us the difficult operating environment they're in, with legislative changes and dealing with customer preferences – it puts them in a precarious position.

    "Our conversation with them is that they need to see how their customers operate, the time and money involved, and how they are struggling with it," he added. "Their customers are hoping for better solutions to interoperate with their community, they are confused over direct messaging and document inquiries and overall they want a better path."

    [Also: HIMSS17 Interoperability Showcase: Cutting-edge technologies, trailblazers and a focus on engagement]

    The evolution of interoperability has been one of fits and starts over the course of nearly a decade and a half. One path has splintered off into different trails, which has made it hard to continue forward, said Theresa Bell, president and CTO of Kno2.

    "The definition of interoperability is a key part of the discussion," she said. "The roadmap from the ONC has veered off into multiple paths, so it has become a 'choose your own adventure book' process. It speaks to the complexity of it."

    Driving forces
    There are various forces at work to make achieving interoperability a difficult proposition, not the least of which is making disparate systems compatible despite a billion lines of code and hundreds, if not thousands of standards.

    Yet there are two major initiatives that are overriding the dissonance and enabling a harmonic convergence – CommonWell and Carequality, said Tushar Malhotra, head of integration at Marlborough, Mass.-based eClinicalWorks.

    "These are the two driving forces," he said.

    The CommonWell Health Alliance provides a mechanism for exchange between providers, based on the concept of establishing linkage with a patient in the eClinicalWorks EHR, managing all the identities at the central level. Once that linkage is established, he said it enables an exchange of data through consolidated clinical document architecture.

    "That is what eClinicalWorks supports as a mean to connect with the set of organizations that are part of CommonWell," Malhotra said. "It allows for easy data exchange between those who are connected."

    The interoperability between eClinicalWorks and CommonWell has existed less than a year, Malhotra said, with the catalyst being "the isolation of the data…the industry wants EHRs to be able to exchange data outside their system boundaries."

    The other initiative, Carequality, started in the same time frame and has rapidly developed in 2016. The biggest advantage, Malhotra said, is that there are no long-term agreements for sharing data, which he calls "a cumbersome process."

    Crosswalking systems
    The computer science term "crosswalking" is at the heart of health IT data conversion projects. Through automated mapping that can be easily pared with disparate codes, crosswalking guarantees better system and user connectivity performance to effectively preserve interoperability efforts, says Sita Kapoor, CIO and chief architect of Piscataway, NJ-based HealthEC.

    Crosswalking helps ensure a high level of interoperability via mapping of healthcare data standards such as HL7, LOINC,  SNOMED, CMS regulations, HIPAA, NLM, Medicare, Joint Commission, CPT, HCPS, NQF and NDC as well as ICD-9 and 10. Data is also archived and formatted in a variety of incompatible file types and data sets across EHRs, acute and ambulatory transactional clinical and financial systems, claims, federal and commercial payers, institution or facility and pharmacy databases.

    "Everyone is trying to achieve data at the point of service and while data is a broad term, healthcare is made up of individuals, one person at a time," Kapoor said. "Trying to process of that is a big challenge and that is where interoperability comes in – how to connect, how to exchange. Crosswalking is between systems, not an integral record we can do anything with."

    Interoperability's journey to date is still in an early stage, Kapoor said, having transitioned from "research and development" to the "engineering" stage, where it continues to be presently. The next stage – which she estimates is still five years in the future – is "production," where "it will become a commodity, where competitive pricing is where it should be."

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    Information governance is what hospitals, and in fact all organizations, need to not only tie together data from diverse departments but to trust that the information is clean, up-to-date, and privacy protected.

    “It really is a concept that applies to any industry, a concept of an overarching program in a collaborative way that provides management across all information,” said Ann Meehan, director of Information Governance for the American Health Information Management Association. “More and more hospitals are adopting this model.”

    Meehan and AHIMA work with hospitals to implement governance strategies. IG can be viewed as the technology guru, cutting across information in various departments, from patient care to financial to human resources and even contracts.

    “People are doing things here and there, not necessarily across the organization,” Meehan said. “There can be two different reports from two different departments, on the same thing. Collaboration gets tripped up. Some people think it’s another level of bureaucracy. My point is: how many times do we have to pull a team together to fix something retrospectively?”

    Perhaps its biggest selling point is that information governance saves money.

    “If we’re wasting time on the back end trying to figure out what went wrong with the front end, we will ultimately reduce costs because of (IG),” she said.

    Standardized data helps with payment reform, bringing together the different alphabet soup of terms.

    Three areas payment reform should address are improving the patient experience, population health and cost, Meehan said.

    A new administration doesn’t change that.

    “No matter what President Trump does, it’s going to address those three things,” she said. “At the end of the day, we need trustworthy information. MIPS, APMs, no matter what payment model is imposed upon us.”

    Meehan will address “Governing Healthcare Information for Payment Reform” Wednesday, Feb. 22, at 11:30 a.m. to 12:30 p.m. in Room W307A.

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


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    Digital Health Solutions, a startup launched by two Indiana University School of Medicine professionals, is commercializing software it said will help pediatricians better target care for their patients.

    The tool, called Child Health Improvement through Computer Automation, or CHICA, augments electronic health records to help physicians better assess patient risks, identify problems earlier and better document care quality. It was developed by DHS President Stephen Downs, MD, section director of Children's Health Service Research at IU, and Tammy Dugan, senior software developer at IU and chief technology officer of Digital Health Solutions.

    The pediatric population "doesn't get as much attention because of the reimbursement structures in hospitals," Dugan said in a statement.

    By licensing CHICA through the Indiana University Research and Technology Corp., the aim is to offer pediatricians a tool that can help improve care for children.

    The technology works by first screening families in office waiting rooms via an electronic tablet that asks 20 questions.

    "Based on the family's responses, the software uses its prioritization process to select the most important issues for the physician to address during the visit," Downs added. "The family can provide information on a wide range of topics, including general preventive counseling, asthma, attention deficit hyperactivity disorder, autism, domestic violence, iron deficiency, lead exposure, maternal depression, tuberculosis and more. It also allows physicians to alert patients to problems that may otherwise be overlooked."

    When physicians access a patient's EHR, the embedded link connects them with CHICA.

    "Once the doctors have checked all the boxes, indicating how they responded to the alerts, the information is submitted as a block of text to EHR software that can then be incorporated into the provider's note, thereby streamlining clinical documentation," said Dugan.

    "Payers of health care are looking for ways for providers to demonstrate superior-quality care," Downs said. "The system captures data that improves and demonstrates the quality of care, which could be used to improve reimbursement. It also collects patient-reported information that can't be captured any other way."

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    Acknowledgement of the value of interoperability – and the desire to implement it – are seemingly widespread in healthcare. So why is the industry still so short of achieving it? For many reasons – technology, financial or logistical obstacles, a lack of standardization, fear of new procedures, or data gaps in EHR systems – the goal of being able to easily and securely exchange accurate patient data across healthcare providers remains elusive.

    Technology isn't enough
    Getting a handle on advancing interoperability requires that technical and business process/policy challenges are addressed together, instead of in isolation, so that there's an integration of technology and policy workflows and scaling. "Simply putting the technology in peoples' hands isn't enough," said Steven Posnack, director of the Office of Standards and Technology for the Office of the National Coordinator in the U.S. Department of Health and Human Services.

    "There need to be business agreements in place and, in many cases, a business model around exchanging information that impacts the delivery of care." Whatever the intention is – e.g., sending a patient for a referral, requesting information from a patient or sending an electronic prescription -- the training and workflow implementation involved with interoperability technology must make it a more usable and seamless part of the health information technology and patient care delivery infrastructure.

    Last-mile problems: the failure to communicate
    There's also a gap – one of what David C. Kibbe, MD, president and CEO of DirectTrust, calls "last-mile problems" delaying full-scale interoperability adoption – between the fairly robust and reliable ability of networks to move health information data from point A to point B and the ability to use that data for clinical decision-making.

    That's because not all of the endpoints – the sending or receiving EHRs – can readily send or receive the information. He likens it to making a phone call where the connection is strong but the cell phone you're calling "only receives messages in French. So if you send a message where you happen to be speaking in English or German or Spanish, that particular party at the end of that phone call won't understand it."

    A corollary to that is the lack of uniform standardization for CCDAs, the formatted data messages for clinical summaries that can be generated and digested by electronic health records.

    "One of the problems with interoperability is that the CCDA is still interpretable in different ways," observes Kibbe. "So not every electronic health record can understand every other electronic health record's CCDA." The result can be the transmission of copious amounts of extraneous data content that the receiving provider doesn't need and can't use, instead of the core data requested for care coordination. However, efforts by ONC and private industry players are under way to obtain standardization for efficient and reliable content exchange.

    Getting connectivity with existing EMRs
    There is an inherent challenge to interoperability presented by the simple fact that there are, perhaps, hundreds of competing electronic medical records proliferating whose construction is such that they don't match up with one another. "They don't have interchangeable parts," said Rich Parker, MD, chief medical officer for Arcadia Medical Solutions, a major aggregator of EMR data from disparate systems on behalf of health care provider organizations. "It would be like saying a Honda and a Ford have interchangeable parts."

    Nevertheless, this challenge is being met in a couple of big ways – through federal rules promulgated in recent years that require electronic medical records to share some interoperability features in order to be certified; and by what companies like Arcadia do. "Say you're a group of 1,000 doctors operating on eight different EMRs," Parker said.

    "Instead of trying to figure out how to plug them into each other, which you really can't do, or spending millions of dollars to convert them all to one system, which usually is too expensive, you let a company like us come in and connect them." That, however, can take several months.

    That dovetails with the suggestion from Erin Sparnon, engineering manager in the health devices group at the ECRI Institute: that "it would be more fruitful" if hospitals focus less on new technologies and more on getting support from their vendors to make their existing health information systems – into which they've sunk huge amounts of money – interoperable.

    A key to innovation
    According to Leigh Anderson, chief information officer at Premier, Inc., the core data that providers need to integrate from multiple sources is financial, or claims information, and – most importantly – clinical. "The reason why clinical data is important is for population health management," he said. "You must understand the sickest people across the continuum so that you can effectively target your resources to make sure they stay well."

    In Anderson's view, one way to use that data innovatively is through an HL7 standard that could deploy it for analytic visibility or workflow purposes and really make a difference. The hoped-for result is interoperability at a deeper level than a traditional HL7 solution.

    "That's how I think you start to get innovation in health care, which is what I think the purpose of interoperability is, so that you're not just doing interoperability for it's own sake," Anderson said. "It's probably the most exciting thing to come along from an interoperability perspective in awhile."

    The financial impetus
    Fee for service arrangements, in Kibbe's view, tend to be the fundamental impediment to interoperability adoption, because they don't incentivize care coordination or discourage duplication of services.

    But with value-based, or risk-based, payments, it pays for providers to avoid such duplication "and to be more careful about surveying the information that comes in about the patient from somewhere else, particularly if it's recent," he said. Were the method-of-payment balance tipped more in favor of value-based arrangements in the U.S., and paired with quality and cost control incentives, "I think we would see these issues of interoperability disappear over a period of five to six years," Kibbe predicts.

    Often, the biggest impetus towards interoperability is financial, where in markets that are shifting from a fee-for-service to global payment platform, actors such as state Medicaid agencies or commercial plans are insisting on it. In Parker's view, organizations that "are feeling that financial threat will be more prone to move forward with interoperability because that's the only way they'll be able to get all of their patients in one system, to be able to do population health."

    The missing link
    There's an elephant in the room here, too: Federal law prohibits the Department of Health and Human Services from setting a standard for a unique patient identifier. Beyond initiatives in which ONC, CHIME and HIMSS are involved – separately or in collaboration – to match patients with their correct data, industry organizations, including CHIME and the American Medical Association, see the adoption of such an identifier as critical to addressing many, if not most, of the problems associated with blocking interoperability.

    "The prohibition on establishing a national patient identifier, as you might imagine, hasn't helped us meet the challenge of patient identification," said Sparnon.

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    "Data is the currency of the next century," says Brian Ahier. And nowhere are health data and data management processes discussed, analyzed and examined more than at the annual HIMSS Annual Conference and Exhibition.

    I have a confession to make: I am a data geek. I love the clear and precise nature of data. Data are foundational to everything. Properly organized data become the building blocks for information, which leads to knowledge and ultimately, wisdom. Medicine is a data rich science, with both structured and unstructured data of a variety of types. If you are a data geek like me then health care should be in your sweet spot.

    And nowhere are health data and data management processes discussed, analyzed and examined more than at the annual HIMSS conference. However, gathering and aggregating these data, even as discrete elements, is of limited value if they can not be shared. Interoperability is required to really make use of these data and a business model that considers hoarding data to be some sort of advantage is doomed to fail. Data longs to be free.

    True interoperability
    Interoperability is a hot topic in health care right now, and we are sure to see it come into focus at HIMSS17. Interoperability between systems and platforms helps improve performance and helps ensure the right data, at the right time, is where and when it is needed to provide the best possible care. Nationwide interoperability is expected from the U.S. Congress, based on the MACRA Law as well as the 21st Century Cures Act.

    The entire health care industry, including providers, payers, vendors, policy makers and patients, have come to understand the critical need for interoperability to succeed in a transformed health system that pays for value and outcomes rather than procedures or number of visits. A physician friend of mine puts it like this: "I want to get paid for what I do for my patients not what I do to them," she says. "But I can't manage what I can't measure, and gaps in data lead to gaps in care."

    There are a number of initiatives and coalitions attempting to address this need; the Sequoia Project (with the eHealth Exchange and Carequality), the Commonwell Health Alliance, and DirectTrust, just to name a few. These are all admirable and successful efforts (disclosure: I am on the Board of Directors for both DirectTrust and the Sequoia Project).

    However, once standards-based exchange is achieved then it is the use of these data that becomes the key focus. Interoperability is the ability of computer systems or software to exchange and make use of information. Simply transferring bits and bytes around is not the end of the story, but only the beginning. Most exchange today centers around transactional data, but patients should be the focus, not transactions.

    Of course peer-to-peer connectivity using industry standards do help systems to be interoperable, providing possibilities for improved care, and yet clinicians still have gaps in care as the data picture is often incomplete.

    There is also the problem of electronic health record fatigue from having to click through too many screens, which can lead to burnout and further damage the care process. It takes a robust clinical data network to provide a full longitudinal care record, and a well-designed user interface to make workflow adjustments seamless. Extending network reach by getting the data clinicians need more quickly and efficiently will help to solve for some of these issues.

    With a powerful network clinicians can focus on the latest, consolidated clinical data which are relevant to a specific encounter. By injecting concise clinical views into workflows more quickly, clinicians are able to spend more time caring and less time searching. Cain Brothers consider data in their Healthcare Success Hierarchy (see image above) and state, "The best way to think about data is to picture it as the middle layer in a three-part hierarchy that depicts the climb between care delivery and customer engagement."

    Data storage today is almost boundless and very inexpensive. Hard drive capacity has increased 250,000 times over the past 60 years, while the cost per MB has dropped more than 99.99 percent. My smartphone has way more data storage capacity than my first computer did 30 years ago. With cheap, ubiquitous data, we are aggregating massive data repositories, creating what many people call "big data."

    These data are valuable, but only if they can be combined and analyzed in ways that provide actionable insights. Today's search algorithms can find targeted data almost instantaneously, identifying patterns and building a foundation for analytics tools that collate, assess, interpret and visualize data and bring meaning to unstructured information. These tools, when used intelligently, foster informed decision-making.

    Data is the currency of the next century
    As the movement towards value based care continues to accelerate, the value of your data asset increases. As I have said - data is the currency of the next century. Others have drawn an analogy to energy calling data the electricity of our generation. Any way you look at it, data is right in the midst of health reform and innovation.

    I agree with Andy Slavitt, former head of CMS, and Vndell Washington, MD, former National Coordinator for Health Information Technology, when they wrote in Health Affairs that data are "the lifeblood of the value-based payment environment,” and they identified the elements needed to “ensure a data-rich, patient-centered, and value-based health care system."

    In the real world, data is often dirty and messy: using incorrect or overly complex terminology, values with incorrect units and no interpretation, or unstructured data which is difficult to parse. Therefore, data normalization is an important concept to keep in mind. Normalization occurs by organizing data such that we reduce data redundancy and improve data integrity. Clean "good" data obviously has greater value. We look at the value of a strategic data asset in three tiers:

    • Data has value
    • Organized data has increased value
    • Organized and normalized data has exponential value

    Scott Fowler, MD the CEO of Holston Medical Group, wrote recently that collaboration is the best way to speed problem-solving and  work toward achieving the Triple Aim – and that open platforms are key to enabling that.

    He is exactly right. The old way of thinking is not going to work in a transformed health system. This is important work, for the economic security of our country, but most importantly for the health and wellness of those we love. No one company or person can solve this alone. It is only by working together that we can fix our broken health care system. But together, we can do this.

    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 year 2016 was a big one for interoperability — particularly FHIR (Fast Health Interoperability Resources) development and the implications the emerging standard has for EHRs, health information exchange and population health. Even still, hospital CIOs and IT executives face a number of pressing questions.

    "The major EHR and interoperability vendors embraced FHIR with enthusiasm, and many are now delivering working technology previews," said Greg Kuhnen, senior director of research at Advisory Board. “That’s remarkable progress for a standard that has no regulatory mandate or direct financial incentive.”

    With the first official release of FHIR expected to become available for mainstream use in 2017, that momentum is poised to continue if not accelerate. And with the partnership between Carequality and the CommonWell Health Alliance — which Kuhnen called “the proverbial golden spike that unites the two competing nationwide exchange networks — a foundation is being laid for wider health information exchange.

    And as it has become clear since HIMSS16 this past year, EHR vendors backing FHIR and growing HIE networks are setting the stage for data-intensive initiatives such as population health, precision medicine, and value-based payment models. Likewise, value-based payments and quality reporting incentives are creating greater demand for information across the entire care continuum.

    "CIOs need to understand the business and clinical importance of data exchange within their systems so they can build a case for strategic investments in interoperability," Kuhnen said.

    Indeed, as EHR vendors adopt and hospitals implement electronic health records software that uses FHIR to advance interoperability and HIE, the functionality that enables will open new opportunities to better serve healthcare consumers.

    "If the goal of interoperability is to create a cohesive record and experience, then we must also recognize that the value of a seamless, loyalty-building and efficient experience outweighs any level of technical interoperability," said Hollie Freeman, managing director of technology at Advisory Board. "We must intentionally keep the view of the patient and family at the center and build experiences and interoperability around that principle."

    Freeman explained that such experiences will ultimately overlay FHIR, EHR and HIE underpinnings, while Kuhnen added that interoperability will one day fade into the background as a technological enabler. 

    "How can interoperability help us keep a consumer centric point of view?" Freeman asked. "Solving hospital and health systems’ process problems is important, but the gains will only come if the experience is seamless for the consumer."

    Freeman will be at the Interoperability Showcase discussing this and other matters at HIMSS17. 

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


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    The National Institute of Standards and Technology's recent study, "Examining the Copy and Paste Function in the Use of Electronic Health Records" aims to shed light on the widely-used but controversial copy and paste functionality in EHRs, exploring how care providers use it and seeking ways to ensure it maintains patient safety.

    Previously, ECRI's Partnership for Health IT Patient Safety has issued four recommendations for clinicians' use of copy and paste: Provide a mechanism to make copied/pasted data more easily identifiable; make sure the provenance of such data is readily available to anyone accessing the EHR; ensure staff are trained about the appropriate and safe use of copy and paste; and work to ensure those practices are regularly monitored and measured.

    In this report, researched in partnership with ECRI and the U.S. Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center, NIST's human factors research uncovered some potentially problematic trends with regard to volume, attribution and veracity of clinical data when copy/paste is used.

    By examining the AHLTA electronic health record platform used by TATRC, NIST found that an essentially unlimited ability to extract volumes of data with copy and paste can cause important pieces of patient data to be missed in overpopulated fields full of "convoluted and/or irrelevant information."

    But clinicians need to know where that data came from: "who copied and pasted it, what was added to/edited in the information and the date and time the information was copied and pasted."

    [Also: AHIMA calls for curbing copy-and-paste]

    Given that EHR end-users sometimes forget or neglect to properly review and edit all the data they've copied and pasted, and that oftentimes they're not provided with system features that enable efficient editing, that can lead to issues with the material's accuracy and usability, according to NIST.

    As such, the report offered several recommendations for safe use of copy and paste.

    First, it bolstered ECRI's call to develop a way to make copied/pasted data more easily identifiable.

    "EHR systems must be designed to enhance the visibility of the information being selected for copy and paste to prevent users from inadvertently copying only part of the information that was intended to be copied which could minimize the possibility of incomplete reuse of information that could lead to morbid/mortal errors," according to the report. "EHR systems should provide a concept for reconciling that the copied information was read consciously and edited by the clinical provider which would promote the attribution of the source of the information."

    Next, it also agreed with ECRI that the source of duplicate material should be made readily discernible.

    "User interface must display the 'chain of custody' of the information associated with the use of copy and paste," said NIST researchers. "However, this information should not be displayed by default, and be shown only on user demand to avoid the possibility of overwhelming clinical users and contribute to errors of commission (taking an incorrect action)."

    NIST also offered additional human factors recommendations for other key clinical areas such as vital signs, allergies, surgical notes, medication entry discharge summaries and more. They can be seen in the full report at NIST.gov.

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  • 02/07/17--11:41: 12 Must-Have EHR Features
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    EHRs are growing in complexity, but not all EHRs are created equal. Just like the needs of your patients, each practice has different needs. Take a look the checklist to help you find the right solution for your practice.

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    San Juan Regional Medical Center, a 194-bed acute care hospital and Level III Trauma Center in Farmington, New Mexico, will deploy an integrated clinical, financial and population health management system from Cerner.

    The new technology replaces more than 75 health IT applications.

    “This decision will provide our physicians and clinical care teams access to sophisticated information technology and systems designed to improve the quality and safety of patient care while also improving the efficiency of documenting and communicating clinical information throughout San Juan Regional Medical Center and its outlying facilities,” Jeff Bourgeois, president and CEO at San Juan Regional Medical Center, said in a statement.

    San Juan Regional Medical Center will implement HealtheIntent, Cerner’s population health management platform designed to aggregate data from multiple sources.

    San Juan Regional Medical Center’s clinicians will use HealtheEDW, Cerner’s enterprise data warehouse solution, to gain insights and analyze population- and enterprise-level data to improve care coordination across their community.

    The integration of Cerner’s Millennium EHR and revenue cycle management solutions combines clinical and financial information within a single platform, which results in what Cerner calls a “Clinically Driven Revenue Cycle,” which is designed to enable clinicians and staff to update the billing process throughout the patient’s visit, enhance clinical documentation to help improve reimbursement and limit claims errors. 

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    The Department of Defense turned on its electronic health record pilot MHS Genesis at the Fairchild Air Force Base in Spokane, Washington, Defense Healthcare Management Systems announced via Twitter on Tuesday.

    This is just the first phase of the DoD's massive EHR revamp, which has been in the works for the past four years. Cerner and Leidos won a $4.3 billion contract in July 2015 to help modernize and consolidate the military EHR.

    [Also: DoD says scaled-back Cerner EHR rollout will now begin in February 2017]

    "This is an exciting milestone for our team. We worked hard to get to our first (initial operating capability) site, and I can report first hand from the command center that everything is going as expected," DHMS Program Executive Officer Stacy Cummings, told FCW.

    "Providers at Fairchild are treating patients while the government and contractor team are quickly implementing fixes to issues as they are identified," she added.

    Genesis was scheduled to launch in December at two facilities, but was bumped until Feb. at only Fairchild. At the time, Cummings explained to reporters the delay was caused by the identification of some issues and more time was needed to ensure the best possible platform for the initial fielding sites.

    Roll out of the second site is slated for June 2017 at the Oak Harbor Naval Hospital in Ault Field, Washington.

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


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    With barely one-third of physicians saying they're satisfied with their electronic health records, its time their voices were heard.

    While some speak optimistically about the "post-EHR era," electronic health records are still very much a going concern – and will be of great interest to many of the 45,000 or so attendees at the 2017 HIMSS Annual Conference & Exhibition later this month.

    There will be education sessions on topics ranging from enabling EHR analytics to resolving usability issues that could impact patient safety to better integrating genomics data into clinical workflows. There's even a half-day User Experience Forum at HIMSS17 –  a major theme of which will be the ways UX can be improved for care teams to create a more transparent, intuitive way of care delivery.

    Long story short: For all their ubiquity, EHRs still have a lot of improving to do.

    [Also: A guide to EHR trends and sessions at HIMSS17]

    As a physician informaticist, I'm fortunate to be invited to many meetings about electronic health record optimization: big meetings, small meetings, fantastic meetings … YUUUGE meetings.

    But there is always one thing, or rather, person, missing: Inevitably, I'm usually the only doctor in the room … and I haven't seen an actual patient in more than five years!

    With only 34 percent of physicians reporting that they are "satisfied" or "very satisfied" with their EHR according to a 2015 survey conducted by the American Medical Association, this is a definite problem. Not only that, but as the AMA's Vice President of Professional Satisfaction Christine Sinsky, MD, and colleagues reported, physicians spend another 1-2 hours on computer and other clerical work during their personal time each day, contributing to the increasing rate of professional burnout.

    Nearly every hospital and health system has an EHR in place, and are hard at work optimizing their investment in a system that typically cost millions or even billions to implement. EHR optimization, for those unfamiliar, is the continuous improvement of the primary technical tool that provides care to the patient through the clinician. Healthcare organizations are simply not going to get the results they want if practicing physicians aren't at the table.

    To a layman reading this, this sounds laughable that they are not at the table. Just having guys and gals like me – "the geek doc," "the techie nurse," or "the ex-clinician turned 'suit'" – is not enough. While we haven't forgotten the years we spent providing care for patients at the bedside, you must include the current bedside providers into the decision-making processes.

    I understand this is easier said than done – doctors are among the busiest people on the planet, and most do not show up or speak up if it means leaving their patients or taking a significant productivity hit (code word for "financial"). Many clinicians will remember the days of pharma reps bringing in catered lunches in exchange for some of their time. I think the question you need to ask yourself is: "What is the new drug rep luncheon that we can offer busy physicians in order to get a bit of their time to get feedback, versus make a sales pitch?"

    In my 15 years of expertise, most physicians and nurses care about "buttons, clicks and lists," which translates to usability, configurations, and technical workflows that match their real-world workflows. So the next question you should have is "How do we get this level of input without needing them to leave the bedside and join a meeting?" I'm glad you asked. I will put on my technical and organizational 'chef hat' to share with you a few recipes for getting the docs and nurses to the table!

    Here are the top five ways to bring doctors to the EHR optimization table:

    1. Email. I know what you're thinking: Did he really open No. 1 with email? Don't doctors get enough messages already? Keep reading: They do, but in my experience in leading EHR efforts at healthcare organizations across the country, it still works. Be sure to leverage the account they use most—for many docs, this is not their hospital-issued account and may be the Gmail account they check every evening instead. If you're unsure, ask them which address they prefer to communicate about EHR matters, which is their new "black bag." Asynchronous (non-real time) communication allows physicians to respond on their schedule. It might take a while to get a reply, but if you include a clear call to action and it's formatted properly, you'll get it eventually. Which leads me to my next point…

    2. Images. As I mentioned above, most of the time when you're seeking physicians' opinions for EHR optimization, it centers on how something looks or feels to them: Which design for a particular screen do they prefer, or which workflow diagram makes more sense for their reality? When you can use images—a screen capture or mockup, a Visio, a chart—you're much more likely to get a response. Try to avoid the tyranny of choice by giving no more than three options per question, and always remind them what the current state looks like alongside the future state options: Physicians are typically visual learners, and they also may not realize what the current state looks like. You'll get a much better response when presenting the status quo and three redesigned options under consideration versus a "Here's the new design for this alert, what do you think?"-type question. Minimum 'free-thinking' allowed: Provide focused and well vetted choices.

    3. Screencasts. If a picture is worth a thousand words, how much are short videos worth? Screen recording technology tools such as Camtasia and Snagit are inexpensive and user-friendly ways to showcase and explain EHR changes or proposed changes. Other industries have used this method for years, and it often can replace an in-person meeting. EHR builders and analysts can record themselves actually going through a new screen or workflow in the EHR, as they explain what they are doing and why it was designed this way. Doctors can easily watch the video on any device; the small .mp4 files can be sent via email, and email replies or comments on the video itself (preferably web hosted, but follow the guidelines of your health system and vendor) make it easy and efficient to collect physician feedback. Your technical teams will love it as well.

    4. Surveys and polls. I've used tools like Surveymonkey for over a decade to survey physicians across organizations. They can be accessed inside or outside of organization firewalls and can be incredibly effective. For example, you may have an EHR developer or analyst create various options for the physician home screen. By embedding images with clearly written captions in the survey, you can get a clear indicator for which one is preferred. This method also gives you objective feedback, which can often be better than random anecdotal feedback—which is the most common thing heard in meetings with many docs. You can use the survey results as support for critical decisions. I once had a doctor voice concern about the new format of an order set, but when I was able to point out that more than 80 percent of her peers selected it as their top choice, she was more amenable to the decision given that so many of her peers had weighed in favorably, and objectively. I've coined this "evidence based optimization!"

    5. Meeting etiquette. If you've tried all of the above, and you just really need an in-person meeting, follow these simple etiquette tips to make doctors more inclined to participate. Depending on the group(s) you're targeting, you may have different optimal meeting times. For example, you'll have the best luck with primary care docs around the lunch hour, but hospital-based docs are usually more available in the early mornings or evenings. No matter when you schedule it, be sure to use the best virtual meeting tools you can afford, so docs have no problem logging on and viewing the deck if they're remote. You can also record the meeting to share with those who couldn't attend. If you can't schedule an exclusive meeting, try to negotiate a bit of time during a meeting already on their calendar, such as a recurring "med exec" (hospital meetings that docs typically attend) or "monthly ambulatory practice management" meeting. Design meetings to cater to "WIIFM" (what's in it for me): Before gathering their input on EHR changes and the like, provide a few tips and tricks that can help streamline their current EHR workflow right now. Once you have the "oohs and ahs," the door will be open for gathering their feedback and their suggestions will be more candid and focused. By continuously showing them the results your EHR optimization efforts are achieving, the more invested they will be in the ongoing process.

    Nothing is foolproof, but I'm confident that using a combination of these methods will help you bring doctors to the EHR optimization table at your hospital. The pharma reps may bring the food, but effective EHR optimization efforts using the above methods can engage clinicians and garner candid feedback–and that's a pill that's not hard to swallow.

    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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    Atlanta-based Grady Health System, one of the largest safety net hospital systems in the country, has earned Stage 7 designation.

    Stage 7 is the top level on the HIMSS Analytics Electronic Medical Record Adoption Model,  otherwise known as EMRAM.

    Grady is Georgia's only adult acute care hospital to earn the highest rating for improving patient care and safety through health information technology.

    "We demonstrated that our advanced use of technology and data is making a real difference in how we care for patients and in patient outcomes,” Grady Health CIO Ben McKeeby said in a statement. ”The effective combination of our people and technology has driven clinical quality and financial improvements throughout the organization.”

    One example is Grady's infectious disease program. Grady implemented alerting for clinicians within the  EMR and recommended ordering pathways to screen patients for HIV and link those patients to treatment.

    The result? A 96 percent reduction in transmission of HIV, when the patient is in treatment. Grady has identified and linked hundreds of patients to treatment through the program.

    "Grady implemented a Meds to Beds program focused on reducing 30-day readmissions and improving patient experience,” added Philip Bradley regional director, North America, healthcare advisory services, operations at HIMSS Analytics.

    The health system has increased revenue and decreased 30-day readmissions as a result.

    Grady will be recognized at the 2017 HIMSS 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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