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    For all it success in spurring uptake of electronic health records at hospitals and physicians practices, meaningful use didn't necessarily incentivize effective interoperability – especially not at the long-term, post-acute, home care and other settings where it could truly drive value.

    Kathleen Sheehan, program director for meaningful use at UHS Inc., says we could be doing a much better job connecting sites across the care continuum. And there are several reasons for – and remedies to – that, which she'll be discussing at HIMSS17 along with her colleague, Sindhu Raveendranathakammath, a clinical informaticist at UHS.

    "Interoperability is generational," said Sheehan. "Hopefully in the industry there will soon be a paradigm shift and think about the next generation."

    The first generation is secure email, such as Direct messaging, she explained. That works pretty well on the ambulatory side, but Sheehan argues that it's still never quite found its footing as an embedded workflow in the hospital: "How am I going to distribute these things that are coming in by the hundreds, when we don't even have a standard subject line?"

    The second generation is the decentralized, federated model – a commodity-based exchange mechanism that's something "we all need," she said. "But the problem with it is that it's voluntary membership, so already you've got vendors fighting: 'I don't want to be in the same sandbox with you.' But we need seamless exchange. If we have five or 10 federated models they're all going to have to talk to each other, seamlessly, if we're going to experience the true benefits of interoperability."

    One unintended consequences of the EHR Incentive Program, of course, is that eligible providers and eligible hospitals were the only entities incentivized to adopt certified technology. Long term and post-acute care were left out of the meaningful use mix.

    "So what's the consequence? Well, we're a far cry from having a complete digital record," said Sheehan.

    What's more, even among those eligible providers who were incentivized, health information exchange remains low in many cases. At UHS, for example, "our performance for exchange under meaningful use in 2016, our highest was 30 percent. Why? Because there's not enough community providers to send electronic mail to, because they don't have it."

    Sheehan contends that there's a better way forward – that providers should be able to embrace more inclusive, less restrictive methods of data exchange.

    While ONC may have meant will with its stringent requirements for certified EHR technology, Sheehan argues that "we don't have to wait for everyone to adopt certified tech to wait for the benefits of interoperability. Providers need to know the value proposition associated with exchange. They don't need to have a certified EHR. If we can just get exchange rolled out across the continuum, that's interoperability. "

    Sheehan recently asked her providers to show her an inbound or outbound CCD from their certified EHRs. "We couldn't believe how all over the map they are," she said. There was all sorts of extraneous information, the display and organization of the data was sometimes confusing, the "look and feel" of the documents varied widely.

    The healthcare industry – providers, policymakers, vendors and others – need to come to a consensus on the "key components for meaningful exchange, and then let's start exchanging them," said Sheehan. The idea of federated exchange is so tantalizing, but "we're still struggling with membership and what to exchange," she added.

    "The technology really holds so much promise," she said. "But how do I sell across the continuum, even to providers who don't have certified technology? Because many don't even know there's a value proposition in exchange. Someone needs to tell them there is!"

    Partly, she said, that's job of those "in the business of creating these products – creating the demand for them: Is it relevant at the point of care? Is it meaningful? What's my confidence level in the accuracy of it?"

    Policymakers still have a guiding role to play, she added, but "I think it's going to be the private sector that does this."

    If we can get to that "next generation" of easy, seamless widespread exchange, the benefits will only proliferate, said Sheehan. Health information exchange is "a silver bullet in reducing costs associated with duplication. It will improve quality too, because then the other silver bullet is care coordination, which is huge."

    Sheehan's session, "Overcoming challenges/obstacles to achieving interoperability," is scheduled for Tuesday, Feb. 21, from 10-11 AM in Room W311A. 

    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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    The EHR vendor’s chief executive weighs in on the industry's most exciting opportunities to improve care ahead of HIMSS17 and into the future.

    The healthcare industry has seen a lot of change over the past decade, from increased regulatory focus to mass deployment of a now digital US healthcare “chassis”. In the wake of the recent national election and looking ahead to continued healthcare reform, 2017 looks to be a year of both great opportunities – and subsequently great challenges - for those across the care and payment continuum.

    The emphasis on consumers and the delivery of exceptional patient care remains clear, illustrated by three key trends to watch for in 2017 – the shift to true value-based care, a continued emphasis on interoperability, and the increased realization of precision medicine.

    1. Value-based care: Finding strength in patient-centered, collaborative care networks
    The shift to true value-based care is moving full-steam ahead. Leadership within the healthcare industry is focused on the Institute for Healthcare Improvement’s Triple Aim – higher quality, lower costs and better outcomes – and increasingly models aimed at reaching those goals are gaining traction.  In fact, CMS recently announced that more than 350,000 eligible clinicians are enrolled in four of the available alternative payment models for 2017, reflecting a strong increase over prior years.

    With legislation and federal regulations, such as the MACRA, shifting the reimbursement model from volume-based payments to a more comprehensive value-based framework, care providers have begun in large numbers to employ new strategies to help them meet requirements and provide the best quality of care. We anticipate a further increase in the development of patient-centered care models, as well as additional engagement with patients who seek to own and understand their own health data. Forward-looking organizations will use analytics to drive outcomes by applying claims, cost and clinical data. And members of patients’ care teams will be encouraged to seamlessly work together to create community based, individually optimized care for their patients.

    2. Interoperability:  Growing demand for true community connectivity
    Care coordination, the organization of patient care activities between the healthcare professionals involved in a patient’s care, is only possible if the multiple stakeholders across the industry work together to share critical information. We are making progress toward interoperability, but the demand for true connectivity continues to grow. In fact, the new care models expanding at the sponsorship of both public and commercial payers, require health IT infrastructure that can facilitate interaction between multiple technical solutions, devices and applications in a more streamlined, scalable and efficient way.

    A key component of this infrastructure is the open Application Programming Interface (API). APIs are sets of tools and specifications that describe how software should interface with each other. Fully supported APIs come with sample code, documentation, sandbox environments, training, and live resources to help navigate the process. They improve collaboration with EHR vendors and allow healthcare organizations to configure their workflows, patient engagement strategies and business management with less customization of their EHR. APIs also tend to be very accessible, easier to use and a lower cost option when compared with other integration efforts.

    The U.S. government will continue to be involved in interoperability efforts. Congress recently passed the 21st Century Cures Act, which gives us the first codified definition of interoperability in the U.S., and we can anticipate Congressional offices and the Department of Health and Human Services to closely watch progress and measure whether MACRA does, in fact, drive more collaboration and connectivity, and therefore, innovation.

    3. Precision medicine: Proactively providing genomically-aware care
    One of the most exciting trends to watch in 2017 is precision medicine. Genomic information presents potential for precise diagnosis, optimized treatment and predictive aspects to keep patients healthy, as well as curing people faster when they are ill. Until now, medical knowledge and therapies were tested on broad populations and prescribed using statistical averages. That meant treatments would ultimately work for some patients, but not for many others.

    The approach of employing precision medicine signals a shift from generalized medicine – the traditional one-size-fits-all and trial-by-error approach - to a personalized care methodology with testing and treatments specifically tailored for individuals. It factors genes, environment, lifestyle factors and family history into clinical decision-making for earlier, more accurate diagnoses, as well as more effective treatment and prevention.

    Patients aren’t the only ones whose lives will be improved by precision medicine. Precision medicine is already positively affecting providers (for example, by reducing ED visits by 30% through application of molecular profiling treatment strategy); payers ($25 billion expected annual spending on genetic tests by 2021, and 45% of FDA approvals were geared toward targeted therapies in 2013); and pharma (the pharmacogenomics market is expected to be $7.5 billion by 2017).

    This is an exciting year for health care. There will be challenges, but if we continue to move towards a more open, connected community of health, we can work together to deliver higher quality care, lower health care costs and achieve better outcomes for our patients.  

    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 Kansas Health Information Network in Topeka knows that patient empowerment is key to improving population health —and it knows that patients need help to be a part of the process.

    That’s why KHIN has found a way to enable patients to receive all of their health information in one location, rather than through the more traditional electronic health record-tethered patient portal, which forces patients to use a portal for each provider. Instead, KHIN connected the HIE to a statewide patient portal in January 2015 and is now able to send patients their care summaries from hospitals and clinics across the state as well as sending discreet HL7 data.

    “We automatically forward to a patient’s EHR, via the portal, anything that we get, including notes and reports,” said Laura McCrary, KHIN’s executive director. “We didn’t think it was a big deal but, apparently, this isn’t done much across the nation.”

    The beauty of it is, patients don’t need to sign in to three or five portals only to write down the information from one on a piece of paper and transfer it to another. KHIN keeps it all together for them, McCrary said.

    “It’s all we can do to get them to log into one portal,” she said.  KHIN’s portal provides “a more holistic set of information for patients.”

    Authentication is critical to KHIN’s success and the HIE found that traditional methods used in the financial industry, for instance, were not working because patients often did not remember the necessary information. So KHIN took a different tack and began authenticating patients with information that was already in their EHR, such as doctor’s name, medical conditions, last treatments, McCrary said.

    The HIE also built a portal into the state’s immunization registry that allows patients to download a copy of their immunization records, or those of their children.

    “It’s one of the things our patients asked us to do, and it has helped out tremendously at the beginning of the school year when parents need vaccination records fast in order to send their child to school.”

    McCrary and Brenda Olson, vice president of the health information management at the Great Plains Health Alliance, also located in Topeka, will give a presentation at HIMSS17 in Orlando on Feb. 20 titled “Statewide Portal - Advantage for Patients and Providers,” from 10:30 to 11:30AM in Hall F3. 

    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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    Entrepreneurs and upstarts in the show floor nooks and crannies are a great place to find new ideas, insights and technologies that foretell coming trends. 

    One of things I do every year at HIMSS is walk around all the vendors on the edge of the hall or in the secondary hall. I have come to appreciate this time as “walking the fringes.”

    These are the small startups, the entrepreneurs who define the next breakthrough ideas, products and services that are at the core of healthcare technology ingenuity.

    There are a few ideas that I am particularly intrigued about in 2017, and am interested to see addressed in various facets by the participants, vendors and patrons.

    One trend that is forthcoming is the evolution of various electronic communication tools that are replacing the phone call in patient and consumer interaction with providers. Not patient portals, not social media, but innovative ways to interact with the patients and families in real time without using a phone … in the way that they want to interact with their provider. As an example: live chat.

    Another development, research data automation. These are complex tools to automatically de-identify, synthesize and compile large research data sets. The upshot for health systems is that these technologies can be used by researchers to commission complex datasets  in an automated way in order to  make use of large amounts of real patient data organizations have in a safe and appropriate way.

    By walking the fringes every year I see at least one company that is truly exciting and ground breaking, and I always follow up with them. This is where I get a lot of my own new ideas and insights.

    David Higginson is CIO at Phoenix Children’s. 

    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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    A recent report from Black Book Market Research shows 41 percent of hospital administrators are still finding challenges exchanging electronic health record information with other providers. A disheartening 25 percent say they can't access any patient data from external sources.

    As health systems lean on their EHRs to help them tackle population health management for value-based reimbursement, clearly vendors whose products can easily connect with other platforms are preferable. Black Book shows that its top-ranked vendors make use of HL7's FHIR specification to drive interoperability.

    "Integrated delivery network EHRs are the future's source for trusted provider data integration and leading to the increase in physician EHR replacements in line with the hospital system," said Doug Brown, managing partner of Black Book, in a statement.

    When hospitals make use of FHIR-optimized systems, he added, "the entire provider network gains the data exchanging functionality to better serve patients. Physician groups continue to lack the financial and technical expertise to adopt complex EHRs which are compulsory to attain higher reimbursements by public and private payers."

    [Also: Meaningful use expert: Time to think about next generation interoperability]

    Other findings from Black Book show continuing struggles for physician practices and the hospitals trying to connect with them. The firm polled more than 3,300 EHR users, who weighed in on their use of – and satisfaction with – the systems. Among the data points:

    • 70 percent of hospitals aren't using patient information outside their EHR, saying that provider data is missing their EHR systems' workflow;
    • 22 percent of medical record administrators said what transferred information was available wasn't presented in a useful format;
    • 82 percent of independent physician practices said they weren't confident that their EHRs had the connectivity and analytics capability to manage the risk requirements of accountable care;
    • 63 percent of those physicians said they're considering joining a larger integrated healthcare organization for technology and financial reasons;
    • 92 percent of hospital executives said the reimbursement realities of Medicare's Quality Payment Program will lead to more physician and post-acute provider acquisitions this year.

    The good news: Some EHR vendors are getting the job done. Of those polled for the report, these inpatient systems ranked first in client experience for 2017, according to Black Book:

    • Evident CPSI, for small and rural hospitals with fewer than 100 beds
    • Cerner for community hospitals of 101- 250 beds
    • Allscripts for large medical centers with more than 250 beds
    • Cerner for hospital chains, systems and IDNs.

    Twitter: @MikeMiliardHITN
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    Healthcare systems can now capture, protect and backup MEDITECH EHR data. Snapshot management also provides data protection and recovery and more into one seamless framework.

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    With ransomware a top threat, healthcare systems must have a plan to both protect and recover data in the event of an attack. Using a multi-layer security strategy provides the best protection for prevention and continuing care after an attack.

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    The Office of the National Coordinator (ONC) for Health IT found through a study that privacy and data loss are very much on patients’ minds--and those attitudes have the potential to impact both treatment outcomes and organizational reputations.


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    DirectTrust is calling on the hundreds of electronic health record and health IT vendors whose products have Direct messaging capabilities to improve the usability of their software.

    Listing more than 50 suggestions, the new report, "Feature and Function Recommendations to the HIT Industry to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care" – which is open for public comment until March 30 – was created by a DirectTrust workgroup comprising physicians and nurses with experience using Direct to share patient data and coordinate care.

    It offers recommendations for improving inbound and outbound Direct messages into three categories: required/urgently needed, highly desired and advanced/future development.

    Among those in the most urgent category: EHR software that can send Direct messages in real time, rather than in batch mode; the ability to attach multiple, common structured and unstructured file formats (PDFs, Word docs, CCDA files) to any message and the ability to automate patient matching of incoming messages for patients that already exist in the recipient EHR.

    "We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments," said Steven Lane, MD, clinical informatics director at Sutter Health and co-chair of the DirectTrust's clinicians steering workgroup. "The existing variability in usability among different vendors' products is unacceptably high and poses a barrier to Direct interoperability, and thus to the adoption of secure messaging by clinicians to support common care coordination workflows."

    Holly Miller, MD, chief medical officer at MedAllies and co-chair of the workgroup added that Direct can be used to deliver critical clinical information to physicians inside their own EHR. 

    "Direct interoperability has provided basic connectivity," Miller said. "Now the health IT community needs to enhance usability and address deficiencies and inconsistencies of messaging content and functionality."

    Twitter: @MikeMiliardHITN
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    Healthcare organizations rely on IT teams to carry out their strategic initiatives, such as interoperability across systems. However, in order to deploy these initiatives and comply with federal regulations, organizations need to develop a documented, tested disaster recovery plan.

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    Editor's note: This is part one of a four-part series that will be published throughout the week.

    Consumer behavior has dramatically changed with the introduction of digital and mobile mediums. This is a change that has affected many industries and, while healthcare has been slower to adapt than others, we’re now shifting our focus to embrace consumerism.  

    Traditionally, healthcare has relied on connections among healthcare providers, payers, pharmaceutical or medical device companies and other auxiliary players, while still requiring the patient to manage their own care. The fragmentation of care caused by this delivery model has led to high-cost treatment rather than the prevention of disease through systematic, patient-specific interventions.

    Legislation such as the Affordable Care and HITECH acts, as well as MACRA and increasing global sensitivities to a fragmented healthcare culture, have contributed to the shift toward value-based, consumer-focused care.  

    Under these initiatives, the healthcare industry has officially shifted focus to the patient while establishing a coordinated, cohesive effort among all health industry players to deliver more effective and efficient care. This model also transfers some responsibility of healthcare back to the patient, enabling them to make decisions for their own healthcare across various touchpoints. The high-level motivation behind granting patients access to their health information is the idea that involving them will make them more aware of their health risks and enable them to become more invested in improving their health.

    Projections of global healthcare spend based off historical and current trends indicate an increase from 6 percent of a country’s GDP to almost 9 percent in 2030 and even 14 percent by 2060. The industry can’t sustain that forecast, and providers, vendors and payers alike are being forced to find new ways to manage cost and mitigate risk.

    Our industry is diligently working to understand and address the evolution of the healthcare consumer. However, it is still a reactive response. Instead, we need to proactively and strategically prepare for and manage the evolution.

    The proliferation of smart devices, apps and wearables have the potential to empower individuals to manage their health before intervention is needed. Looking at the demographics of the U.S. market today, millennials have surpassed baby boomers as the nation’s largest living generation, making up nearly a quarter of the U.S. population.

    Millennials are also changing their healthcare consumption habits: 41 percent said they view a doctor as the best source of health information, compared with 68 percent of respondents from other generations, according to a new survey by GHG/Greyhealth Group and Kantar Health. This generation has an appetite for digital resources and consumer-oriented apps that connect their transactions to their personal health journey in real-time.

    While nearly the entire acute care market is live on an electronic health record system, government entities are also investing in digital records and contributing to the advancement of the consumer-oriented healthcare industry. The U.S. Department of Defense selected Cerner’s EHR to connect the health information of servicemembers across the world. This relationship will help Cerner enhance our offering for global consumers and identify opportunities to enhance data exchange among devices that undergo intermittent periods of connectivity.

    Health systems are augmenting their strategies, too. Many are opening retail clinics in local community centers, building micro-hospitals and additional outpatient centers or incorporating new service lines heavily predicated on community involvement like sports medicine outreach.

    As payment reform places a greater emphasis on patient satisfaction and value-based outcomes, many healthcare systems have reacted by adding C-suite executives who are solely focused on the patient experience. The emerging roles in health systems covering this important topic – Chief Patient Officer, Chief Experience Officer, Chief Strategy Officer – are charged to better connect with their patient populations by adopting best practices from other consumer-facing sectors like electronics and the hospitality industry.

    We’re seeing major consumer companies such as Apple, Google and Amazon investing in healthcare, national shopping chains opening retail clinics, health systems opening grocery stores and pharmaceutical companies developing apps for patients to track symptoms and improve compliance. These are just a few of the marketplace innovations and evolutions established as a result of this great consumer behavior shift.

    We’re still at the forefront of healthcare’s consumer evolution. To address our evolving regulatory environment, changing patient expectations and the onset of value-based care, health systems need to continue to adapt and engage with their patients as consumers and understand that consumers in this space will be empowered to dictate what constitutes as value going forward.

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    Not so long ago, the U.S. federal government was honed in on rewarding healthcare providers for IT adoption and healthcare providers themselves were solely focused on the difficult task of hardwiring electronic health records into their daily workflow. With EHRs now nearly universally adopted, that emphasis is changing.

     “It’s more about how we are using the EHR, as well as other technology,” according to Ferdinand Velasco, MD, chief health information officer at Texas Health Resources, a 14-hospital integrated delivery system in North Texas that has a long history of being advanced when it comes to EHR adoption.

    More than ten years ago, Texas Health achieved Stage 7 recognition, the highest level of EHR adoption and implementation given by HIMSS Analytics. Texas Health also received the HIMSS Davies Award of Excellence in 2013.

    “Technology has become the enabler, or a tool to support better management of patient care,” Velasco said. “I think this is a significant shift in focus. Now, we are getting back to our main focus of improving health, and our technology supports that.”

    According to Mary Beth Mitchell, chief nursing informatics officer at Texas Health, the shift in emphasis has allowed more organizations to start focusing on becoming a High Reliability Organization (HRO) — a hospital that reliably prevents harm to patients. 

    Texas Health is achieving HRO status through the use of a Reliable Care Blueprint to drive standardization and high reliability, while ensuring that the system is implementing evidenced-based practice throughout all of its hospitals. “We like to say: every patient, every location, every time,” Mitchell explained.

    In light of the new value-based care reimbursement models, healthcare organizations are trying to determine how they can improve their clinical outcomes while demonstrating true value in what they do, Mitchell added.

    “I think that this work is not easy, but it is necessary,” said Joni Padden, a nursing informatics specialist at Texas Health.  “Through our technology, we have the ability to help drive desired workflows, and then the ability to monitor and manage what we are trying to accomplish through better clinical practices.”

    Mitchell, Velasco and Padden will be discussing ways that Texas Health is managing patient outcomes to adapt to value-based care payment models and clinical outcome requirements at HIMSS17.

    Their session, “Improving Patient Outcomes by Hardwiring Patient Care,” is schedule for Monday, Feb. 20, 2017 at 10:30-11:30 a.m. EST in Room 331A.  

    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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    While healthcare entities are waiting for EHR vendors to make data more interoperable, a raft of emerging technologies are enabling information exchange in ways that work effectively today, according to Lisa Moon, a partner with the Timmaron Group.

    EHR users are caught in a cycle of waiting and hoping that vendors quickly develop systems where data is standardized, accessible and free flowing.

    Standards for healthcare data are beginning to align and, in turn, structured data is shaping up to be the gold standard.

    But data still resides in the EHR, separate, siloed and often unavailable to those who are bound by duty, through role, to collect and then use information in health care delivery.

    With that in mind, perhaps it’s time to look at other solutions beyond what EHRs can deliver. Especially at a time when innovative cost effective options for moving data have evolved to solve the difficult information exchange issues experienced in health care delivery operations.

    One approach is to proactively leverage the real-time hospital event notifications to improve care coordination and help reduce costly re-admissions. Over 34 Million Transition of Care documents were exchanged via the Direct Protocol in Q4 2016. The exchange of these TOC’s can be leveraged as trigger events that generate other notifications to various interested parties. This manner of care coordination is the result of innovative use of the Direct Protocol in concert with other technical tools like Integration Engines, Natural Language Processing and a sophisticated rules engine normally associated with expensive and costly HIE structures. The service is designed to deliver a lightweight, scalable and sustainable solution for data exchange by innovating and reimagining the role of a HISP.

    There are many benefits to this approach. It is easy and quick to implement. In Carlton County, for instance, 35,000 citizens will be covered in an Event Notification System powered by an innovative Direct solution. Funded by the State Innovation Model demonstration, Direct protocol will be used to identify high risk patients and whenever a CCD with one of those patients is exchanged the processing HISP automatically generates additional notifications to all community partners involved with managing that patient’s care. In this demonstration, a TOC that was originally sent to a PCP will be the trigger to send additional customized notices to a LTC facility, a specialist or multiple specialists or even to the patient themselves.

    What is important to note is this approach does not require more coding and database changes to the hospitals EMRs or any further collaboration by the EMR vendors. Instead, it leverages innovative Direct products.

    The CDA document is a standardized Structured Data Payload. The amount of data contained in a CCD has been a problem, often overwhelming the receiver of that document and rendering it useless. This again can be solved to make the data more accessible and actionable by customizing a payload to the needs of the receiving party.

    These actions to transform data are taken on while data is in motion to deliver a customized summary alongside the complete CCD. This approach directly addresses the costs and concerns of HIE models which are still struggling to find sustainability. But most importantly it demonstrates that healthcare providers can free the data without having to wait on EHR vendors – by simply redefining the functions of a HISP.

    Data is a strategic asset. EHR vendors have little economic motivation to share data. Their business model is built upon multiple revenue streams including fees associated with charging for patient data. Until that model changes health care organizations, providers and collaboratives who rely on data for insights will be at a disadvantage.

    Fortunately, new products are developing and a significant amount of progress has been made throughout the industry in the past few years.

    Seamless and ubiquitous health data needed at the point of care, however, is still an evolving concept and one that the health care delivery system cannot rely solely on EHR vendors to solve.

    Lisa Moon, partner in care management and applied informatics with Timmaron Group, is also a PhD candidate in nursing information science and a former public health official. 

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    Editor's note: This is part three of a four-part series that will be published throughout the week.

    Interoperability is a key area of emphasis in modern healthcare. New technology has made the exchange of health information between systems easier and faster, forging the path for a robust health IT ecosystem devoted to advancing patient care. Though there's still a marathon ahead of us as we work toward this goal, interoperability has become the rallying cry for innovative providers devoted to putting the person at the center of care.

    One of the challenges of advancing interoperability lies in consumer expectations. As technology has become more sophisticated, so has its users. Patients now demand timely access to their health information, and they want as few impediments to that access as possible.

    It's not just a consumer expectation, either. Data access has become a regulatory requirement. Beginning Jan. 1, 2018, as part of the Stage 3 meaningful use  program set by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT, all healthcare providers will be required to give consumers direct connectivity to their healthcare data using application programming interfaces.

    [Also: Healthcare should embrace consumer-centered, proactive revenue cycle management]

    Many provider organizations are recognizing the downstream impact this new patient access API requirement has to their existing patient engagement strategies. In preparation, Cerner been working with our clients to create an approach that facilitates easy data sharing through APIs, as required by MU3, while also unleashing the potential of open APIs more broadly to enable innovation at scale. Standardized APIs will extend the functionality of electronic health records and other emerging solutions by establishing the technological foundation for providers to share information and enabling apps that can be used by patients and providers to improve care.

    Open APIs are not a new phenomenon. The financial, retail and technology industries are already utilizing APIs to revolutionize standards and expectations for consumers. Consider the way Google uses APIs to integrate their services with other platforms: If you've ever pulled up Google Maps on your iPhone or accessed a new service using your Google login, you've experienced the full convenience that a comprehensive API strategy can create. When compared to other industries, healthcare has incredible opportunity to leverage open APIs to accelerate innovation and amplify the value of clinical systems and platforms.

    In healthcare, the emergence of APIs will enable software developers to create new applications by fully leveraging the underlying health IT systems. This type of access introduces collaboration opportunities for developers who can create tools granting users secure access to health information from various sources. In the last few years, we’ve observed apps using standards like SMART Health IT and HL7’s Fast Healthcare Interoperability Resources (FHIR®) go from early prototypes to pilot projects to at least a dozen examples in use in the clinical setting today.

    We need to work together as an industry to develop the rich experience consumers have come to expect. A prime example came last year as the ONC challenged healthcare providers, major technology suppliers and app developers to demonstrate a real use case for an API-connected app that patients could use to manage their medications from multiple sources. Together, Trinity Health and several large technology companies, including Cerner, showed how three distinct apps could use the medication lists retrieved using APIs from multiple source systems in unique ways. In the coming months, we will have patient-facing APIs broadly deployed in healthcare, which will enable developers to create a wide variety of apps for consumers.  

    [Also: Healthcare industry, or consumer health industry?]

    When people living with chronic conditions have complete access to their EHR data via API-enabled apps, for example, they will be able to make more informed decisions about their health and care. This concept exists in tandem with the push toward value-based care, because when consumers are actively involved in their care plans, providers are better able to tailor care, monitor progress and intervene at critical times. Ultimately, by getting consumers actively engaged in their health and care, they will be able to make healthier decisions and lead healthier lives.

    It's important to recognize that patients will always receive care across multiple venues, and that means healthcare providers must learn how to exchange data for the good of the person. In implementing an API strategy, we're not only enabling providers to take better care of their patients, but we are empowering consumers to take charge of their health and care.

    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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    A new health plan data exchange service from athenahealth offers support its providers who exchange clinical data with payers for quality management, risk adjustment and performance management programs, the company announced Wednesday.

    The new service creates a direct connection between participating health plans and technology partners, officials said. It connects to athenahealth's EHR, athenaClinicals, digitizing what was traditionally a manual process.

    The goal is to reduce disruption to provider requests, manual chart audits by health plans and deliver clinical data to health plans in a standard format, officials said.

    Jonathan Bush, athenahealth's CEO, said electronic data exchange for health plans will reduce "friction between health plans and providers in clinical data and quality reporting."

    "After hearing from our providers how disruptive manual chart audits are to their practices, and how incomplete the data conveyed through this process could be, athenahealth was inspired to leverage the power of the network to help un-break the data exchange process between providers and health plans," said Bush in a statement.

    The company has already connected with technology firm Inovalon as part of the health plan data exchange service, which automates transfers of structured and unstructured clinical data from athenaClinicals to Inovalon on behalf of athenahealth's clients.

    The new service extends athenahealth's work with payers, which includes medical billing process automation and managing populations under complex payment models with athenahealth Population Health.

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    Epic Systems has forged a deal with Geisinger Health System spinoff xG Health Solutions to embed Geisinger-developed care management content into Epic EHRs and Healthy Planet, Epic’s population health management platform.

    “The unique thing that Geisinger did was that the hard work of codifying medical knowledge in a way the computer could understand it,” Epic President Carl Dvorak told Healthcare IT News. “We’re really excited to work with them on opportunities to share across the community, which is why we’re working with xG, making some of their offerings standard options that people can get with their Epic system and create a community of learning that will funnel feedback and further knowledge into the process.”

    The content will be available for use by Epic clients later this year, and according to xG, Epic is slated to demonstrate how it works with Healthy Planet at HIMSS17.

    The clinical content is based on nationally-recognized practice guidelines and standards of care. It includes assessments and

    care plans for 60 conditions most commonly addressed in care management programs.

    The content also includes evidence-based comprehensive and condition-specific assessments, as well as rules that are applied to assessment responses to produce a patient-specific care plan. The plan includes goals and interventions on an automated basis.

    Dvorak noted that some of the work Geisinger does in Pennsylvania is also applicable in Denmark, the UK and the Netherlands and many other places around the world.

    “The true benefit that’s being done right now is we’re able to encode it in such a way that it can be shared across systems, across the world,” Dvorak added.

    xG Health Solutions CEO Earl Steinberg, MD, said that the agreement enables Epic customers to tap into evidence-based clinical protocols and workflows and do so in a manner integrated with their EMR.

    Geisinger spun off xG started a little more than a year ago and has also licensed the content to Cerner.

    xG executives realized that each EHR maker would use the content in different ways, Steinberg said, while xG focuses on keeping the content up to date.

    Financial terms of the deal with Epic were not released.

    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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    Two-thirds of healthcare organizations have increased staff to boost EHR adoption, according to a study by Nuance Communications and HIMSS Analytics to be released next week at the 2017 HIMSS Conference & Exhibition.

    But increasing staff is not sustainable for these organizations, said Brenda Hodge, senior vice president of healthcare marketing at Nuance Communications, a clinician information systems vendor. What's more, 77 percent of the organizations plan to conduct more training to increase EHR adoption, and 67 percent plan to use different technologies to enhance the EHR experience, including such options as mobility tools, speech recognition at the point of care, and computer-assisted physician documentation, according to the study.

    “Now that everyone has been through the EHR implementation phase, healthcare organizations are trying to realize the intended benefits of EHRs, and there is a lot more work to do to realize these benefits," Hodge said. "And they also are dealing with all the regulations with value-based care that have put an additional administrative burden on clinicians, and thus they are dealing with clinician satisfaction issues now more than ever.”

    Hodge advised healthcare organizations to keep searching for ways to make patient care better for clinicians, as that, in turn, will make things better for patients.

    “We are almost at a crisis in this country with clinician dissatisfaction – the increasing rate of early retirement, people not recommending the field to the younger generation – physician satisfaction is at an all-time low and healthcare organizations need to be looking for ways to make things better,” she said. “Looking for tools to enhance the experience, doing more at the point of care, providing facts and evidence at the point of care that makes their job easier.”

    For example, if a clinician does not see Hepatitis B patients often and she has such a patient in her office, she will find there are 64 different combinations of things she can prescribe for that patient, Hodge explained.

    “So, for instance, with the Nuance artificial intelligence engine serving the right combination up and giving the clinician the answer they need, the clinician can spend more time counseling the patient and making sure the patient is complying with the regimen they agreed to,” she said. “This is the kind of thing healthcare organizations can look at when at HIMSS17, tools and technologies and services that will enhance the experience for the clinician, because such tools will have a tremendous impact for the overall care team and patient care quality.”

    Hodge said another theme that likely will be on the minds of many HIMSS17 attendees will be how to improve quality scores.

    “Quality scores not only impact healthcare organizations’ financials, but we are seeing a lot more physicians personally motivated to improve these scores, in part because their quality scores are documented and published on web sites,” she said. “You can Google and find out your doctor’s quality scores, and that is becoming something consumers are looking at. This is very personal to the clinician.”

    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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    A few tips on how to navigate the exhibit hall

    The countdown to HISS17 continues. As I wrote last week, the best way to think about it is in three ways – education, vendors, and networking. This post is the second in a three-part series – focusing on vendors.

    If you already registered, you have been inundated with vendor emails and snail mail since then. The ginormous exhibit hall beckons when you get to Orlando. So how do you make the vendor aspect of HIMSS17 as productive as you can?

    Here are some tips to consider based on many years of navigating the exhibit floor:

    Meeting with your current vendors– I’ve talked with colleagues in the past who always start here. They schedule meetings in advance or stop by just to say hello at all their primary vendors’ booths. I never fully understood this. Maybe I was a CIO in an organization with mostly internally developed systems for too long. You can connect with your primary vendors throughout the year so do you really have to spend a lot of time with them at HIMSS? It’s up to you and your specific needs and issues. If you want to see the latest and greatest products available or coming in the next year OR you have some big issues to discuss with their executives, it makes sense.

    Visiting vendors that you are evaluating– IT teams are in the planning phase for new systems all the time. If you are using HIMSS to check out the market in a focused product area, this is a great chance to get the lay of the land. Scheduling meetings and demos in advance makes sense.

    Exploring new products– You might be curious as to what new start-ups and innovators are doing and have a list of small firms to check out. You’ll have to work to find them since the big, established vendors buy the best floor space. But do find them – they will most likely be swarming with booth staff ready to talk to you.

    Special showcases– Be sure to check out the Interoperability Showcase to see what level of integration is possible these days. And look for the HX360 Innovation Zone where many new start-ups are demonstrating their products.

    You control your time– Booth staff are there to get your attention and tell you all about their products and services. They will keep you if you’re willing to stay. But you control your time and your plan. If you just need a quick informational conversation, want to pick up some materials, and leave your contact info (or not), then do that. Be polite and respectful but move on when you are ready.

    Being recognized– There are lots of ribbons that attendees can wear on their badges. The CIO ribbon is one that CIOs treat differently – some would never wear it because they think they’ll be aggressively approached by everyone on the floor selling something. I am of the mind that by wearing it, booth staff easily see you are a CIO and a decision maker and you might more easily get their attention when you visit them. Go back to my previous point – remember, you control your time and which vendors you talk to.

    Divide and conquer – Like my advice on education last week, plan with your team if you are going to meet with certain vendors together or you are splitting them up to cover more ground.

    Maps– You can download maps in advance from the conference site. This is especially helpful for planning your time in the exhibit hall.  Make your list of vendors to see, mark up the map and break it down in sections for each day.

    Social media ambassadors– They can help you prepare, keep up while there, and stay connected afterwards. Follow these influencers to get the most out of HIMSS17.

    #HIMSS17 Hashtag Guide– HIMSS has provided a helpful guide that lists key hashtags. Before, during and after the conference these hashtags may be helpful as you focus on what you want to learn about and follow. On both Twitter and LinkedIn, you can find related posts using the hashtags.

    And last, but not least, pack comfortable walking shoes– HIMSS conference veterans understand this. New attendees may not. You will easily walk several miles each day between education sessions and exhibits. Practicality not vanity is what attendees need to think about when packing shoes. Ladies, comfortable flats or low heels should rule!

    This post was first published onSue Schade's Health IT Connect blog.


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    Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus on improving customer satisfaction.

    Electronic health record platforms are among the most complex, interconnected, data-intensive software applications on the planet. Think about the seemingly endless fragments of patient information that an EHR is asked to store and maintain – basic demographics, diagnoses, chart notes, medications, allergies, upcoming appointments, previous surgeries and procedures, historical lab values, imaging studies, standing lab orders, e-prescription transmission transactions, claim submissions, and on and on.

    Physicians and their staff also need to be able to review, transmit, reconcile, approve, and synthesize all of that clinical information to help make better, more informed decisions with their patients.

    In 2008, fewer than 1 in 10 physicians were using an EHR, and the functionality that existed in those systems then would not qualify as a federally certified EHR product now. Over the last decade, to achieve federal certification, vendors worked at a feverish pace to add hundreds of features and change dozens more in order to achieve parity with the rest of the market. This transition from paper to digital happened so rapidly that usability suffered, innovation lagged, and real customer needs were under-prioritized.

    Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus this entire industry on improving customer satisfaction.

    The Office of the National Coordinator for Health IT has attempted to regulate the design of EHRs in a way that has not resulted in broad usability improvements to date. Approaching this immense problem from a more prescriptive regulatory perspective barely scratches the surface of what customers are demanding. While there should be required minimum standards for any software that is utilized by medical professionals to help them manage something as critical as patient health, no regulatory framework for usability will lead to more delightful user experiences for medical professionals or their patients.

    What technology is needed in a modern medical practice?
    Most complaints from EHR users stem from the feeling that the computer interferes with the ability of physicians to provide great, human-centered care for their patients. Many user interfaces look like they are 10 to 15 years old (because they are) and fail to meet customer expectations for how a modern application should function. Alert fatigue, infrequent software upgrades, and inefficient workflows contribute to this general dissatisfaction. In a recent study, researchers found that physicians spend 3 times the amount of time with computers as they do with their patients during a typical day. It's no wonder that EHR usability is consistently rated poorly across most software vendors.

    Physicians and their staffs ultimately need software that supports their practice throughout the entire patient journey. Technology vendors must completely rethink their offerings by applying the essential components of user-centered design that have worked well in other industries.

    Implementing an intentional approach to usable software
    Usable software applications are intuitive, easy to learn, and memorable. They also must be efficient and prevent errors, all while deeply satisfying their users.

    To achieve these six goals in health software, vendors must first gain a deep understanding of how a physician's office works – from the beginning of the day until the lights are turned off. A team of user researchers dedicated to this scientific task, investigating directly in doctors' offices, is crucial.

    Tip: Merely dropping in for a few hours of office time is insufficient.  

    Shifting to a user-centric approach in EHR design also requires gathering as much information as possible about how technology can assist customers with common tasks and data-intensive decisions.

    Tip: It helps immensely to have a central place on the web where customers can request features. Often, the conversation that occurs in the comments section is crucial for software development teams to smartly refine feature requirements and improve usability.

    Executives of EHR companies must embrace and encourage iterative software development within their product and engineering teams, with customer feedback directly informing each iteration.

    Tip: Pair "minimum viable product" software development methodologies with user experience personas to turn users into happy evangelizers of products they love using every day.

    Achieving indispensable EHR technology
    For decades, physicians have pleaded with software makers to build functionality that helps them make better treatment decisions and provide better care for their patients. EHR vendors have instead delivered technology that is minimally usable and slows down the practice of medicine. Fortunately, this is not how it has to be.

    As the entire healthcare industry transitions its business model from fee-for-service to value-based care, modern medical practices will find themselves relying even more on healthcare technology that efficiently collects, reports on, and synthesizes clinical data. To truly capitalize on this opportunity for smarter decision-making that leads to improved patient outcomes, current basic EHRs must evolve into mature, highly usable, indispensable tools that physicians and their staff enjoy using.

    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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    As value-based care increasingly becomes the healthcare norm, it is imperative to effectively address—and eliminate—the costly issues of medical identity theft, duplicate records and payment fraud across the full spectrum of care. These concerns become even more pressing with the growing prevalence of virtual care.

    With cybercriminals and hackers becoming progressively more savvy in breaching health system data centers, and the black market value of protected health information (PHI) being at an all-time high, it is no wonder that an estimated one in three patient identity records are being compromised.1 These alarming facts provide even greater rationale for health systems to secure the “front door” and prevent invalid use of data and greater accuracy of the data collects. Each of these challenges can be overcome by enhancing the health services registration process—starting with a streamlined, standards-based, identity-proofing process.

    The industry can no longer engage the expensive and inaccurate process of eliminating duplicate records by a back-end data recouncilation process that is unable to detect the $84 billion problem of medical identity theft. Even when identity-proofing standards are employed in biometric processes, this measure is primarily applied only within the silo of a specific delivery of care facility and not across multiple care settings. The patient needs the ability to establish one identity across the continuum of care, regardless of the electronic health record (EHR), further maximizing interoperability.

    Without a comprehensive health IT solution to completely eliminate medical identity theft, there remains a continued risk for increased misdiagnoses, ineffective treatment plans and payment fraud. Health industry organizations must implement innovative, customized solutions, from the check-in and discharge area, to the patient room, lab and data center.

    Correctly identifying patients and accurately matching them to their medical records across different healthcare settings is the key to bridging the legacy challenges within the current health system. Think of a health system without duplicate records, without medical identity theft, without payment fraud—yet one prepared to deterministically match patient records as part of a semantic, interoperable health data exchange ecosystem. Technology is evolving to capture and verify a patient’s identity and all associated records immediately upon admission by creating one “single and true” identity for all locations across the entire care continuum. These innovative solutions can help providers:

    • Validate and permanently match patients with their correct medical records.
    • Improve patient satisfaction and safety while increasing data and billing accuracy.
    • Decrease patient processing time, data entry errors and administration costs.
    • Eliminate duplicate patient records that can lead to medical inaccuracy, misdiagnosis and ineffective treatment.

    Virtual care breaks barriers

    An integral element of value-based care is extending medical treatment beyond the brick-and-mortar facilities and leveraging virtual care solutions. Virtual care engages patients who are limited by distance, chronic disabling conditions or the lack of local specialists/providers. Virtual health technologies have the ability to support patients along the path of awareness to wellness via remote data collection, monitoring, diagnostics and caregiver collaboration. With these innovative technologies, patients once isolated from receiving adequate treatment are able to get the care they need in their place of residence, helping to mitigate pervasive health equity and access issues.

    As advanced as virtual care technology is at this moment, the future of this endeavor within health IT is turning new corners daily. Personal devices add a dimension of mobility that can literally bring care providers to the moment of medical crisis. Moreover, new technologies such as voice-activated devices successfully bridge the gap between virtual health opportunities and those patients who, for myriad reasons, are unable to physically use the necessary telehealth equipment.

    Patient identity and virtual care

    But virtual care also expands the aforementioned issues already associated with health IT. All data collection done during these remote sessions must be secure, confirmed and accurately integrated with the patient’s primary record. If the identity of a patient being treated via telehealth cannot be confirmed, it cannot be validated as part of a medical record. The same holds true for the patient data collected in the home and shared with the health team. Thus, to not only ensure security but also patient safety, critical health information needs to have 100 percent confidence in its source, associated identity and ability to be exchanged.

    So when it comes to all facets of virtual care, how can patient records remain secure in settings outside the physical control of the caregivers? How can patient monitoring and diagnostics be accurately linked to the right patient every time? Moreover, it is often the case that virtual care patients are incapable of using the technology hardware that makes telehealth a successful option, whether due to disability or technophobia. What is the solution to effectively engage patients with telehealth solutions in these circumstances?

    It’s time for leaders in IT health to focus on creating virtual care solutions that effectively address patient identity and health record integration issues, while also meeting the challenge to engage at-home patients in this burgeoning care paradigm.

    1. Information Age. Healthcare Fraud Five-Step Plan Diagnosis and Treatment. April 2016.


    By Tom Foley, Director of Global Health Solutions Strategy




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