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    When the Tokyo Olympic games begin in July 2020, the world’s attention will be focused on healthy competition. The people behind a new HIMSS  initiative is hoping they will also learn about the value of improving access to electronic health records.

    Olympic Healthcare Interoperability Initiative (OHI)  is an effort to bring the most advanced health-record sharing standards to the medical services that will be provided at the Tokyo 2020 games and the Olympics that follow.

    The idea came to HIMSS North America Board Member Michael Nusbaum while he was volunteering at the Vancouver 2010 games.

    “They build a whole healthcare infrastructure when they come to town,” he said. “Wouldn’t it be a wonderful idea if we could demonstrate the benefits of interoperability on a world stage?”

    HIMSS CEO Steve Lieber confirms that OHI is a HIMSS initiative and SNOMED will be a partner; a number of other international standards organizations are also supporting the project. OHI is currently in talks with the International Olympic Committee to gain approval for the plan.

    OHI proposes to work with the Olympics medical services team in delivering a fully interoperable infrastructure that would make it possible for athletes’ records to be accessible on site based on recognized international standards.

    OH”s leadership team includes Nusbaum, Todd Cooper, a consultant and expert on interoperability, and Flavia Dias Moreira, a healthcare management consultant who had a leadership role in the Rio2016 games. While the initial focus is on the Tokyo games, Nusbaum said he hopes this initiative will continue through future Olympic games.

    A presentation on the initiative will take places on Feb. 22, 1:30 to 2:30 p.m. at the Interoperability Showcase Theater – Booth 9000.


    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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    ORLANDO ― Personalized health and wellness are the top areas where investors are placing their money, according to Polina Hanin, academy director at StartUp Health, speaking at Sunday’s Venture+ Forum HIMSS17.

    “It’s based on the catalyst of healthcare reform,” Hanin said. “We have to put power in patients’ hands.”

    Patient and consumer experience brought in $2.8 billion in investments in 2016, with an average deal size of $17 million and areas of focus that include nutrition and fitness as well as de-stigmatizing behavioral health issues.

    “The biggest deals have shifted. Based on the larger deals, a lot of money is front-loaded into patient and consumer experience,” Hanin told a full room of investors and entrepreneurs at the forum.

    "We think every entrepreneur is going after a moonshot,” she said.

    But where there are winners, there are losers, and in this scenario, that means electronic health record platforms are at the bottom of the investment pool.

    “No new EHRs are being developed,” Hanin said.

    Also on the decline is provider acquisition of technology companies, she said. Insurers are investing more in technology acquisitions because it’s easier for payers to deploy and run pilot programs, Hanin said.

    According to Hanin’s data, the three top cities for investment in the United States in 2016 were San Francisco, Boston and New York, and for the second year in a row, GE Ventures was the most active investor, followed by Khosla Ventures, StartUp Health, Andreessen Horowitz and BlueCross BlueShield Venture Partners.

    The big players are not just dabblers, Hanin said. Some are investing in six or more companies.

    Digital health has led the way to a golden age of entrepreneurship, according to Hanin. In 2010, digital health companies received a $1 billion investment, which grew to $8.1 billion by 2016.


    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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    athenahealth announced at HIMSS17 that it will roll out a series of “Network Medicine” health campaigns. Working in collaboration with prominent specialty societies, including the American Association of Orthopedic Surgeons, the American College of Cardiology, and The American College of Obstetricians and Gynecologists, these campaigns will surveil athenahealth’s national cloud network, surface patients who may be at risk of various health threats, and engage their providers to accelerate care.

    The vendor said nearly 100 new clinical guidelines are introduced every month, and that many of today’s clinicians struggle to stay up-to-date on best practices, which may lead to missed opportunities, inadvertent outdated treatments or medical errors. By leveraging the scale of its network, athenahealth said it is able to identify and activate providers treating patients who may have a high likelihood of being impacted by recent clinical guidance. As part of this workflow, appropriate care can be delivered more quickly than in traditional scenarios, the vendor added.

    “Keeping abreast of the continuous stream of relevant clinical guidelines and alerts is challenging for any provider, regardless of specialty,” said Thomas Portuese, MD, of the Hudson Headwaters Health Network. “The idea of leveraging a national network to identify patients in need of certain care and activating a care team around them will not only make clinicians smarter, but has great potential to save lives.”

    According to athenahealth, to date it has seen initial success in alerting providers and patients at risk of public health crises such as the Zika virus, identifying more than 6,000 patients at risk of contracting the virus in Wynwood and Miami Beach, Florida, and Rio Grande Valley, Texas.

    “When the Zika virus hit Florida, we were concerned not only about our pregnant patients, but those who could potentially become pregnant,” said Diego Shmuels, MD, director of quality and clinical practice management at Borinquen Health Care Center of Miami Dade. “Together with athenahealth, we were able to activate the CDC’s updated guidelines, identify patients at high risk in our community, and encourage them to come in for screening.”

    Building on this initiative, athenahealth will roll out new campaigns in 2017 focused on preventing medication safety risks during pregnancy, managing opioids and chronic conditions, and adjusting cholesterol treatment for cardiovascular patients.

    “Medicine grows more complex each day, and it’s incredibly difficult for clinicians to stay current on medical innovation, new research and therapeutic interventions – technology must help connect clinical staff to better information without bogging them down,” said Jonathan Bush, CEO of athenahealth. “We’ve made it our mission to build the healthcare Internet to make this industry work as it should. At athenahealth, we can uniquely look across our national network of nearly 88,000 providers, treating millions of patients across the U.S. and identify scenarios to activate care teams and patients. With Network Medicine and in collaboration with the best health and medical expert organizations across the country, we are able to drive better health and, in some instances, stamp out bad medicine.”

    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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    McKesson is showing an early version of its InterQual Auto Review software here at HIMSS17. The product, which comes out of a partnership with the National Decision Support Company, automates medical necessity reviews by tapping into patient data residing in electronic medical records.

    The software ties NDSC’s automation engine, which processes some 3 million data transactions every month, into InterQual’s technology for evidence-based content and automated review.

    “InterQual AutoReview takes discrete data from the EMR and pulls it into our engine that feeds into InterQual Connect to automate evidence-based content and serve clinicians the results they need to see, all in one screen,” said Nilo Mehrabian, vice president of decision management products at McKesson Health Solutions.

    InterQual Connect, which McKesson released last year, integrates the evidence-based capability into the clinician workflow to decrease administrative expense, Mehrabian said. McKesson’s strategic direction has been to make that process easier for providers and payers and enable them to collaborate better.

    “AutoReview brings efficiency in completing these reviews,” she added. “It’s more objective than subjective and improves care for patients as well as increasing efficiency for nurses because they can spend more of their time looking at the exceptions or patients that are not low-hanging fruit.”

    What’s more the software advances exception-based utilization such that clinicians only have to handle exceptions that cannot be processed automatically.

    Mehrabian explained that McKesson started the process with 7 conditions that are high volume cover approximately 30 percent of ED admissions nationally and the company intends to expand to 41 conditions — comprising more than 90 percent of admissions. She also said that thus far approximately one-third of cases get auto-reviews.  

    The software also enables McKesson to be a facilitator of easing prior authorization because once the medical necessity review is conducted, that patient gets submitted to payers for authorization, so having that data come directly from the EHR is going to be helpful, she said.

    “It’s still in development, we are right now in the beta early adopter phase and hope to go general availability later in the year,” Mehrabian said.

    McKesson is in Booth 3479. 

    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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    In 2014, nearly 9 million patient health records were breached in 164 reported incidents. By March 2015, that number had increased tenfold. In fact, it is estimated that one in three health records were compromised during 2016 alone.1 Records can be physically stolen from medical facilities, so it is important to prevent data acquisition in this manner. But with the prevalence of health IT systems in place, cybersecurity—not just on the backend, but with a complete security ring around data—is absolutely critical to eliminate the prevalence of medical identity theft. Health systems must implement a 360-degree risk mitigation strategy to cover every potential breach.

    The impact of medical identity theft

    Protected health information (PHI) is highly valuable on the black market because it can be used to obtain pharmaceuticals, commit insurance fraud or obtain medical care through channels such as Medicaid and Medicare. In fact, according to the FBI, stolen health information currently fetches $60-$70 on the black market, while a Social Security number goes for less than $1.1

    The fiscal impact of medical identity theft is considerable, generating losses to the health industry of more than $30 billion each year. However, patients also sustain financial consequences of fraud, having to pay an average of $13,500 to resolve these issues.2

    The current thinking in the industry today is that performing computer-generated data conciliation processes in the backend increases the risk of data corruption. However, the entire focus of medical identity theft is to emulate another person. While many organizations feel they don’t have a medical identity theft problem (the “it’s-not-me” belief), the astronomical costs tell otherwise.

    But the costs are not just monetary. Medical identity theft can cause delays in treatment, misdiagnosis and inappropriate care. The health data of the imposter is merged with the identity of the real patient, creating serious inaccuracies in health data that can be life-threatening.

    Coincidence or crime?

    Patient misidentification may not necessarily involve criminal activity. Often medical identity issues arise due to the inadequacy of name and birthday as current identifiers. Even if the identity of a patient is verified, there is a significant chance that other patients in that system share the same name or birthday, and sometimes both.

    Although released several years ago, the Harris Health System in Houston published a set of data that demonstrates just how many similar identifying factors some patients share. Among more than 3.4 million patients, two patients sharing the same first and last name occurred 249,213 times. In the same set of data, patients sharing the same first name, last name and birthday occurred almost 70,000 times. Five or more patients shared the same first and last name more than 76,000 times. Are these records unique individuals or duplicates? How many represent different people? Or is medical identity theft a factor?   

    Securing patient identity

    There are numerous coinciding factors that providers use to identify patients. The verifiability and accuracy of these records is imperative for health organizations to keep track of individual patients and manage the overall patient population. To prevent medical identity theft and keep treatment and diagnosis as accurate as possible, health systems need a reliable method of deciphering patients with an uncompromising identity-proofing process.

    Health organizations must invest in the appropriate health IT to ensure patients are not vulnerable to the costly risks of medical identity theft—and that technology must involve identity-proofing individuals across multiple healthcare settings, not just in siloes. Implementing a unique health safety identifier (UHSI) is a great first step in strengthening IT security, preserving data integrity and saving health organizations and their patients’ money. And taking these legacy challenges out of the health IT ecosystem will allow an acceleration toward a value-based care delivery model.

    The success of value-based care demands innovative, reliable health IT solutions. A unique health safety identifier is a positive start to improving data quality at the point of care, as well as along the entire spectrum of care and within the growing virtual care arena. The goal for every care provider must be: one patient, one identity, one record.

    1.http://www.information-age.com/technology/security/123461306/healthcar-fraud-five-step-plan-diagnosis-and-treatment April 2016.

    2.Medical Identity Fraud Alliance. Fifth Annual Study on Medical Identity Theft, February 2015.

     

    By Tom Foley, Director of Global Health Solutions Strategy

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    ORLANDO - McKesson is showing an early version of its InterQual Auto Review software here at HIMSS17. The product, which comes out of a partnership with the National Decision Support Company, automates medical necessity reviews by tapping into patient data residing in electronic medical records.

    The software ties NDSC’s automation engine, which processes some 3 million data transactions every month, into InterQual’s technology for evidence-based content and automated review.

    “InterQual AutoReview takes discrete data from the EMR and pulls it into our engine that feeds into InterQual Connect to automate evidence-based content and serve clinicians the results they need to see, all in one screen,” said Nilo Mehrabian, vice president of decision management products at McKesson Health Solutions.

    InterQual Connect, which McKesson released last year, integrates the evidence-based capability into the clinician workflow to decrease administrative expense, Mehrabian said. McKesson’s strategic direction has been to make that process easier for providers and payers and enables them to collaborate better.

    “AutoReview brings efficiency in completing these reviews,” she added. “It’s more objective than subjective and improves care for patients as well as increasing efficiency for nurses because they can spend more of their time looking at the exceptions or patients that are not low-hanging fruit.”

    Because the software advances exception-based utilization, clinicians only need to manage exceptions that cannot be processed automatically. The new version is estimated to cover about 30 percent of ED admissions. McKesson plans to expand support to 41 conditions, which will cover more than 90 percent of admissions. Mehrabian said that, at present, approximately one-third of cases get auto-reviews.  

    The software also enables McKesson to be a facilitator of easing prior authorization because once the medical necessity review is conducted, that claim is submitted to payers for authorization, so having that data come directly from the EHR is going to be helpful, she said.

    The product is still in development. “We are right now in the beta early adopter phase and hope to go general availability later in the year,” Mehrabian said. McKesson is in Booth 3479.

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    Author: 
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    http://pages.healthcareitnews.com/How-do-HCCs-impact-the-shift-to-value-based-payment.html?topic=medicaremedicaid%2C%20qualitysafety%2C%20reimbursement
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    CMS is moving aggressively to shift healthcare payments towards value-based payment models. How do hierarchical condition categories (HCCs) affect reimbursement for health systems and physicians? What are best practices for accurately capturing HCCs?

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    Author: 
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    External url: 
    http://pages.healthcareitnews.com/Are-Your-Claims-Ready-for-Value-Based-Reimbursement.html?topic=medicaremedicaid%2C%20qualitysafety%2C%20reimbursement
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    How can you succeed under new value-based reimbursement (VBR) models? For starters, healthcare systems must document and code full patient acuity, not just conditions treated during a visit, in order to represent a patient's true health risk.


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    http://pages.healthcareitnews.com/7-Steps-to-Improve-HCC-Capture-for-Value-Based-Payment.html?topic=medicaremedicaid%2C%20qualitysafety%2C%20reimbursement
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    For large integrated health networks, what impact do hierarchical condition categories (HCCs) have under value-based payment models? The short answer: a big one. Learn the seven steps to consistently capture accurate HCC categories for each patient.


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    Lorraine Chapman, senior director of healthcare at Macadamian, a UX design and development firm, said here at HIMSS17 that "healthcare is late to the game in terms of user experience." 

    For any patients put-off by impersonal-feeling portals, or providers frustrated by ungainly user interfaces and counterintuitive workflows, that sentiment might be something of a no-brainer.

    But at the half-day HIMSS17 UX Forum, designers, developers, clinicians and patient advocates put their heads together to find ways to create technology that's not just usable but "delightful" – for caregivers and patients alike.

    In the kick-off session, Chapman – along with Kyra Bobinet, MD, CEO of engagedIN, her neuroscience behavior design firm, and Rick Starbuck, senior vice president of product and experience design at Change Healthcare – compared notes on how healthcare could learn from UX leaders such as Apple and Disney to create impactful and lasting demand for their products.

    Past HIMSS surveys have shown significant problems with UX for clinical documentation and nursing: too many clicks required by EHRs, poor templates that affect data quality, difficulty in communicating context and reasoning and design-hampered challenges with workflow and care-coordination.

    There are two components to good UX, said Bobinet. The most basic is "just to not tick people off." The other, more advanced opportunity is to elicit "delight," she said.

    In an industry like healthcare, where the caregivers are often harried and patients can be distressed or frightened, that's a challenge. But beyond the obvious benefit to the end users, it has ROI for vendors said Chapman, who noted that for every $100 spent up front in product development, "the cost of fixing issues later doubles, if not triples."

    Smart UX strategies "save you from wasted product development cycles, and ensure that what you produce is meeting a need," she said.

    "Most of what is missing in experience design, especially as we lean more on technology," said Bobinet, is the human element. "The brain hasn't developed for chatbots and apps," she said. "So if I'm going to drive value, I'm going to have to nail this emotional design."

    That's made doubly difficult in health IT, of course, where product development for clinical systems is often hamstrung by federal certification checklists.

    On paper, those requirements "might look good, but with implementation it doesn't feel right," said Chapman, who noted that it's critical to "put the user at the center of the (design) framework," considering their emotional needs, workflow requirements and more.

    There are three main components to product development, said Starbuck: needs, solutions and validation. "A lot of companies focus in the middle," he said, "and miss the needs and validation parts."

    Key doing better is to embrace behavioral science, said Bobinet: "When you know where the brain is going to go, you don't have to spend so much time guessing or iterating."

    Behavior science "is the new wave of design," she added. "It's the third leg of the stool. It's not enough to just do market research and segmentation of personas. You have to start with the science."

    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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    What a difference one year can make. In the world of Epic founder and CEO Judy Faulkner, where creating new technology meets with a delight for words, 2016 was a productive and rewarding year.

    How so?

    “We’re developing some really nifty new software,” she told Healthcare IT News on Sunday after attending the daylong CHIME-HIMSS CIO Forum at HIMSS17.

    “There’s going to be three versions of Epic,” Faulkner said. “That’s what we’re working on now. There’s Epic Sonnet.” She pauses to note that an “epic” is a long poem – as in Homer’s Odyssey. As she put it, “even though we’re computer scientists, we can still be literate.”

    Sonnet, she said, is the smaller poem. She describes Sonnet, which is now in development, as Epic technology with some of the features removed. It has a lower price point, and it can be just the right technology for organizations who don’t need the features of the full Epic EHR. Then, there’s yet another version, one between the full Epic EHR and the Sonnet. Both will provide a path toward upgrading to the full product.

    “We’re finding that people need different things,” she said. “So, if you are a critical access hospital, you don’t need the full Epic. The two new versions of Epic in development can provide a pathway to adding all the features at a later time.

    And then there’s “Caboodle” – the name of Epic’s data warehouse. “I don’t like boring words,” Faulkner said.

    The trade name for these tools used to be Cogito, from the Latin phrase “ergo sum” – “I think, therefore I am.” In mid-2016, Epic renamed the data warehouse “Cabooble” and Faulkner is now working on Kit – as in Kit & Caboodle. “Kit is making everything very open,” Faulkner said.

    Faulkner seems to relish her work and is buoyed by it. Is there any time when it becomes a grind?

    “Some parts do,” she replied. “Sometimes what becomes a grind is not the work itself, but how long it takes and how much of my life it takes and how little I have for other things.”

    However, there are rewards – for example, knowing that there are so many drug-to-drug interactions – a quarter million – averted through Epic system alerts.

    She’s also pleased that Epic customers have done well financially, she said. Yes, Epic EHR installations are known to cost millions of dollars. But, Faulkner has done the math and created charts. Over the years 2004 to 2015, and across all healthcare organizations, she believes that Moody’s and Standard & Poor's statistics demonstrate that Epic customers reaped profitability unsurpassed by clients who implemented her competitors’ EHRs.

    For Faulkner, 2016 was a very good year, indeed. From June through December, family members from around the world visited her and her husband in Madison, she engaged in work she loved, and she was often inspired.

    Who inspired her the most in the past year? It was Mona Hanna-Attisha, MD, the doctor who — with the help the Epic EHR at Hurley Medical Center in Flint —Michigan, discovered the extent of the Flint water crisis.

    “If we did not have Epic, if we did not have EMRs, if we were still on paper, it would have taken forever to get these results,” Hanna-Attisha was quoted as saying.


    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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    Earlier this month, the HL7 Argonaut Project published its FHIR Data and Document Query Implementation Guide, which it bills as a "major step forward" for the agile interoperability standard.

    At HIMSS17 on Tuesday, Argonaut leader Micky Tripathi offered updates on the new guide, and put the project's accomplishments these past three years into perspective.

    The Argonaut Project, launched under the HL7 umbrella in 2014, comprises heavy hitters from both the vendor and provider sides: Accenture, athenahealth, Cerner, Epic, McKesson, Meditech, Surescripts, The Advisory Board Company, Beth Israel Deaconess, Intermountain, Mayo Clinic, Partners HealthCare and Boston Children's Hospital.

    "The idea was to get a group of implementers together, people who do this for a living, providers and vendors, to accelerate the use of FHIR and make it more practical and real for people," said Tripathi, CEO of the Massachusetts eHealth Collaborative.

    "It's completely private sector initiated and funded, not an ONC edict," he said. "The private sector needs to be stepping up more, to take over interoperability."

    The release of the new implementation guide is significant, said Tripathi. If interoperability standards are "ingredients," he explained, the new Argonaut guide for high-priority use cases is like a "cookbook," explaining how to put it all together.

    The Argonaut Project is so named because it was formed in the wake of the landmark JASON report, "A Robust Health Data Infrastructure," in which a government advisory panel of scientists was "highly critical of where we were in healthcare" with regard to interoperability, said Tripathi.

    Back then, Tripathi had some disagreements with the report's findings. "There's probably more progress in various types of health information exchange than the JASON authors seem to give credit for," he told Healthcare IT News in 2014. But it's also hard to argue with JASON's recommendation that healthcare data exchange make much better use of public APIs.

    Current interoperability is largely based around HL7's Consolidated Clinical Document Architecture standard, but that's a "complex vehicle for exchanging data, and somewhat unwieldy," said Tripathi. "It's got structured data embedded in it, but it's all wrapped up in a document.

    "If you just want a particular data element, like an allergy, you get a C-CDA," he added. "I might not want the whole C-CDA, but it's the only show in town. C-CDAs work for a particular kind of use case, but sometimes you just want data elements for quality measurement, or clinical decision support – or, increasingly, the kinds of lightweight apps people are developing."

    Indeed, beyond just being cumbersome, C-CDA is "too myopic, and "too healthcare-centric," he said, "creating barriers for innovators everywhere else in the economy who are doing all sorts of great things. Those developers have no interest in coming into healthcare if it's going to be based on C-CDAs."

    FHIR, on the on the other hand is flexible to both document level and data level exchange and is based on modern internet conventions. It’s a RESTful API that developers from outside healthcare can pick that up and say, “That, I understand."

    The Argonaut Project prioritizes speed-to-market, gathering the stakeholder input needed to make FHIR "relevant and usable," said Tripathi. "We need to have more of a way to get market input into the development process, get collaboration and consensus, as early as possible."

    Epic, Cerner, Meditech and others are already basing their APIs using Argonaut guidance. The new FHIR implementation guide hopes to spark even faster adoption of the standard in 2017 and beyond.

    This year, the Argonaut Project plans to broaden its focus to other use cases for FHIR and OAuth standards, said Tripathi, such as a scheduling API to enable better appointment functionality across EHRs (thus enabling easier referral management for ACOs tackling population health management), and work to enable better integration of external apps into EHRs.


    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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    ORLANDO – The rule was only finalized four months ago, but we're already in the initial performance year for the new Merit-based Incentive Payment System, which ushered in sweeping changes for how clinicians get reimbursed as part of MACRA. On Tuesday at HIMSS17, two officials from the Centers for Medicare and Medicaid Services offered a detailed primer on two of the more technology-intensive components of the program.

    With the new payment framework, "clinicians can pick their pace," said Molly MacHarris, program lead at the Quality Measurement & Value-Based Incentive Group at CMS.

    The agency has heard from stakeholders that "we were moving a little bit too fast," she said. "We wanted to take a step back and ensure that anyone who wants to participate in the program can participate."

    That said, she added: "The more active a clinician's participation is in the program, the higher their potential score."

    Medicare clinicians who participate in MIPS will be reimbursed based on a score of zero to 100, determining whether they receive a bonus or a penalty. The score is weighted according to four components: Quality (accounting for 60 percent in year one), Cost (zero percent for the 2017 transition year), Advancing Care Information (25 percent) and Clinical Practice Improvement Activities (15 percent).

    The session on Tuesday focused on the latter two, ACI and CPIA, which depend especially on use of certified EHR technology.

    The performance period for this first transition year can be as little as 90 days or as much as a year, but data must be submitted to CMS by the end of Q1 2018, said MacHarris. By the middle of that year, CMS will give feedback on performance, and then payment adjustments – whether bonuses or 4 percent penalties – will begin in 2019.

    Those eligible professionals who participated in meaningful use will be familiar with the approach to ACI, said Elizabeth S. Holland, senior technical advisor at the Division of Health Information Technology, Quality Measurement & Value-Based Incentive Group at CMS.

    Advancing Care Information, she said, is "based on, but not identical to the EHR Incentive Program." (Which continues on, incidentally, for hospitals and Medicaid-eligible professionals – although the latter group can participate in both MIPS and MU.)

    That component is calculated using a base score, a performance score and a bonus score. The base score measures clinicians on security risk analysis, e-prescribing, patient access and sending of summaries of care. Performance score assesses patient-specific education, view/download/transmit, secure messaging, patient-generated data and more. Bonus scores can be improved by more advanced capabilities, such as chronic care management and capture of patient-reported outcomes.

    As for Improvement Activities, clinicians can choose from more than 90 initiatives grouped in nine subcategories: Expanded Practice Access, Population Management, Care Coordination, Beneficiary Engagement, Patient Safety and Practice Assessment, Participation in an Alternative Payment Model, Achieving Health Equity, Integrating Behavioral and Mental Health and Emergency Preparedness and Response.

    Much more detailed explanations of how the component scores are weighted and calculated can be found at CMS.gov.


    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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  • 02/22/17--06:52: HIMSS17: Tuesday Highlights
  • The action continues on day two of HIMSS17 with a Women in Health IT Roundtable, Cybersecurity Command Center presentations, and more. Attendees share what they've learned from the hundreds of education sessions and why they return year after year.


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    Logicalis Healthcare Solutions, part of international IT and managed services vendor Logicalis US, has introduced at HIMSS17 a new service desk offering, dubbed Service Desk for Epic.

    The new service is designed to help hospital CIOs make the best use of their internal Epic resources by giving physicians, nurses and other clinicians immediate access to a pool of Epic IT specialists for tier-one support. This should allow hospital IT staff to focus on broader issues such as workflow and user training that will increase clinician, and ultimately patient, satisfaction, Logicalis said.

    “A number of our healthcare clients requested that we create a service desk offering specifically tailored to Epic implementations,” said Ed Simcox, practice leader at Logicalis Healthcare Solutions. “Through Logicalis’ new Service Desk for Epic, we want to empower our healthcare customers to make the best and highest use of their Epic resources. By forwarding questions about password resets, recording or locating orders, and other day-to-day tier-one issues to Logicalis, hospitals’ internal Epic resources will be able to focus their time and attention on optimization of their Epic environments.”

    The Epic Service Desk from Logicalis offers a scalable, consumption-based model with the aim of enabling hospitals to better leverage their internal IT personnel by avoiding repeat calls for known issues, the vendor said. With a 24/7 service desk partner experienced in Epic implementations, end-user downtime can be minimized and, in instances where level-two support is needed, root-cause data can be delivered to internal teams to aid in management decisions, the vendor added.

    Logicalis is showing an introductory video to the new technology at HIMSS17 in Booth 779.


    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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    ORLANDO – At HIMSS17 on Wednesday, IEEE Computer Society and the Personal Connected Health Alliance hosted a day-long event focused on the potentially transformative promise of an intriguing innovation: Blockchain.

    Kicking off the symposium, "Blockchain in Healthcare: A Rock Stars of Technology Event," Tamara StClaire, chief innovation officer at Xerox Healthcare made the case that the bitcoin-derived secure digital ledger technology could just maybe offer the answer to an array of vexing healthcare challenges – not least of which is interoperability.

    "The current infrastructure is really inadequate to handle information exchange," she said. "Blockchain has the opportunity to impact those infrastructure challenges."

    StClaire said she was skeptical at first. And she's hardly the only one. Blockchain is just about at the "peak of inflated expectations" on the most recent edition of the Gartner Hype Cycle.

    Nonetheless, "there's a lot of movement there," she said, pointing to two recent studies from IBM and Deloitte. The first showed that 16 percent of payer and provider executives expect to have a commercial blockchain application at scale in 2017. The other found that healthcare and life sciences plan the most aggressive deployments of blockchain across all industries, with 35 percent of respondents saying their company plans to deploy it within the next year.

    "Despite Gartner's caution, a lot of people believe there's going to be momentum and acceleration," said StClaire. It could "impact almost every healthcare transaction" and "has a global ability to change the way we think."

    She offered several potential use cases for blockchain in healthcare.

    Master patient index. Blockchain "could solve the challenge health systems have when their data sets get mismatched, or the problem of duplicate records," said StClaire. For one thing, under the current system, there are "20 different ways you can enter date-of-birth. Not a really great approach."

    Another challenge is that "this information is centralized with a single trusted source – to me that's the downside of the ways we're approaching MPIs today. Even within organizations, error rates for being able to successfully identify or integrate a file are 25 percent; outside the walls, they're 50 or 60 percent."

    But the very nature of blockchain "actually incorporates MPI," she said. "One way to think about it is the fact that not your identification but your data is hashed to the ledger. It's an address you're looking for. And there can be multiple addresses. And a patient can hold multiple keys to those addresses in their electronic wallet."

    One thing that doesn't quite jibe with that approach, however, is when there's an institution that actually owns that patient identification, said StClaire. "If we're going to move to blockchain, we have to tip that philosophy on its head."

    Claims adjudication. Automated adjudication means being able to automatically take a claim and decide whether it's going to be paid or denied without manual intervention. 80 percent of claims are done this way. But claims are getting a lot more complex, said StClaire, and more importantly there's error and fraud already in that 80 percent.

    "There are a lot of processes that can be automated when you think of blockchain that are just slightly peripheral to this," she said, such as "maintaining a benefits database, determining patient insurance."

    Blockchain offers an opportunity for "disintermediation and trustless exchange," said StClaire. "To me, this is when we think about the whole process of claims as an area that can be completely disintermediated. She pointed to the use of blockchain's so-called "smart contracts," where the network can agree upon the way the contract is executed.

    "An easy win here is blockchain-like: Roughly 6 percent of all claims are denied because of incomplete or incorrect information," she said. Blockchain could help by enabling the updating of information continuously and distributing it to the right network.

    Interoperability. The ability of two or more systems to exchange information, and be able to use the information that's exchanged, working together across organizations to improve patient health, is "the very promise of health IT," said StClaire. "It's what we've been driving for for the past decade."

    But as is widely known across the healthcare industry, it's much easier said than done.

    "Blockchain has the opportunity to help us with interoperability," she said. "If we think about a health chain, we can use industry standards related to APIs to exchange patient information. The challenge with this is it really tips ownership on its head, tips access on its head."

    Longitudinal health records."A lot of these use cases stem from the way we think of healthcare now," said StClaire. "But if we think about what blockchain can do, these use cases blend into each other.

    "If we think about a longitudinal health record, one of the reasons this is important: most of us go to our primary care roughly 54 percent of the time we engage with care. The other 46 percent (of clinicians) doesn't have a complete view of our health history. We need a clinical summary, view into what's going on with that patient: labs, treatments, diagnoses."

    Blockchain methods could help speed the way toward the "Holy Grail," she said: a longitudinal view, including inpatient, ambulatory and wearable data, that could help with more "innovative ways to deliver care.

    Supply chain. By leveraging blockchain-based smart contracts and the Internet of Things, healthcare organization can "monitor something through its entire lifecycle," said StClaire. "Determine when someone gets paid, determine whether contracts or agreements are executed properly and on-time. I know several folks on the supply side of healthcare that are very interested in this application."

    Clinical Trials."One of the things you can think about is having a layer where you have data and information, deidentified and available," she said. "As researcher in clinical trials, you can imagine having access to this wealth of data that now is completely siloed to help you recruit patients for clinical trials or help you to do research. This is a platform that could actually get us there."

    Stakeholders are aligning
    StClaire rattled off a list of recent blockchain-related activity that suggests a keen level of interest in its potential applications in healthcare. ONC's Blockchain Challenge got more than 70 white paper submissions. Philips Healthcare has launched a lab specifically aimed at blockchain research. The Hyperledger Healthcare Working Group features participants such as Accenture, Gem, Hashed Health, Kaiser Permanente and IBM. The MedRec platform developed by the MIT Media Lab and tested at Beth Israel Deaconess Medical Center is decentralized EMR management using blockchain tech to manage authentication, accountability and data sharing.

    Still, she said, "it's really responsible for us to think about some of the challenges that are still ahead."

    There are technical hurdles aplenty, of course. But academia and industry trying to solve them, and at any rate, "they're really minor compared with inertia."

    Among the technology-specific challenges: blockchain ledgers, with their secure blocks, make it hard to gain insights from the data. "It's difficult to think about how you do analytics on encrypted information," said StClaire.

    "People tried to take the information out of the blockchain to do analytics, but then you really destroy the whole reason you have it on the blockchain, which is security and privacy," she said. "There are a lot of smart minds rallying around how to do this. One is called homomorphic encryption."

    Another challenge is related to proof of work, she said. "The way verification and validation is done with bitcoin takes a lot of energy, it's really not scalable for healthcare. And so again, the industry is looking at ways to tackle that." One of them is blockchain's "proof-of-stake" algorithm. "It's where you now have this permissioned network, versus this permissionless network. The folks within that network are responsible for verification and validation."

    The fact that blockchain gives patients more control over their data is also something else to consider. "Think about transferring ownership of data to patients," she said. "All of a sudden we have a new paradigm about the way we think of privacy. We may need to set default levels for the people who are uncomfortable with the magnitude of that responsibility. There's a lot we need to dig into, and that conversation needs to start."

    As for regulation and oversight, "we need regulatory bodies at the table," she said. "One perspective is that we don't want to get regulators involved yet because we don't know what to ask them to regulate at this juncture. And I think that's probably pretty right on. But at some point you want them at the table so they're comfortable with what we're putting forth."

    The biggest challenge to blockchain's potential, however, is industry inertia, said StClaire.

    "In some ways we're serving up some of the potential answers to some of the biggest challenges we've been facing in healthcare over the past couple decades. But if you think of the business models of some of the big incumbents: Owning this data, keeping it siloed, not making it transparent to other people in the network, especially patients and users. That's a really big hurdle to tackle."

    That said, for all the hype and challenges it seems apparent that this technology has at least the potential for an interesting future in healthcare.

    "I started out pretty skeptical about blockchain," StClaire said. "But when you're in the room with people who are excited about the applications and implications in healthcare, it gets you pretty riled up."

    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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    Nuance Communications and Epic Systems are collaborating on putting artificial intelligence and health IT to work helping wounded warriors.

    There are nearly 20 million military veterans in the U.S., and 4 million have service-connected disabilities, by the government’s count.

    The two IT companies announced at HIMSS17 they would work together to make it easier for disabled veterans to schedule medical appointments.

    Epic's electronic health record, paired with Nuance's healthcare virtual assistant technology, Florence, makes the task easier, Nuance executives say. Nuance’s AI-powered conversational user interface and simple design supports intuitive voice-driven interactions, making it possible to schedule an appointment in seconds, they add.

    Voice-driven workflows will be featured as part of the Medical Appointment Scheduling System program – MASS, a nationwide deployment of Epic scheduling software in VA Medical Centers, aimed at improving veterans’ access to care.

    The goal is to help people with disabilities gain independence and better access to the information they need fast and securely.

    Nuance has delivered speech recognition technology to the U.S. Veteran’s Health Administration System through long-standing relationships across the health system, which includes 14,000 physicians across 152 hospitals supporting more than 8 million patients annually. Nuance’s clinical documentation solutions support all branches of the Department of Defense at hundreds of facilities across the U.S and overseas.

    Satish Maripuri, executive vice president and general manager of Nuance's healthcare division, noted that the company has invested heavily over the past decade to develop conversational and cognitive virtual assistant and AI technologies.

    "This is an important invaluable initiative to help our nation’s veterans get what they need faster and to become more independent," Maripuri said in a statement.

    "We are very proud of our work with Nuance to embed their advanced AI technology into Epic’s EHR to deliver next-generation assistive capabilities to our nation’s veterans," added Epic President Carl Dvorak.

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


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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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    Cancer Treatment Centers of America is implementing a custom technical solution that enables eviti, a NantHealth clinical decision support system, access to clinical workflows in the Allscripts Sunrise electronic health record. The Clinical Pathways program is designed to help inform the cancer treatment process, without interrupting the physician’s clinical workflow.

    The direct interface of the clinical operating system (NantOS) was built with the input of hundreds of oncologists across the nation and holds a comprehensive collection of evolving cancer care data, the vendors said.

    “Cancer Treatment Centers of America, Allscripts and NantHealth began planning this project in early 2016 to help patients and providers alike benefit from the clinical capabilities of an integrated solution,” said Paul Black, Allscripts CEO.

    [Also: Soon-Shiong debuts AI, cloud platform, says FDA gives nod to cancer vaccine]

    The resulting Clinical Pathways integrates the latest cancer research available, treatment regimens and complementary therapies into the Allscripts Sunrise EHR, giving oncologists the ability to create a curated list of care protocols at the point of care, the vendors explained.

    When the treatment platform is engaged, the vendors added, it can be used for comparing treatment options, computer order entry, as well as access to referenced guidelines including response rates, adverse drug reaction and toxicity.

    “Clinical Pathways presents all appropriate treatment options,” said George Daneker MD, chief medical officer at Cancer Treatment Centers of America at Southeastern Regional Medical Center. “It also helps eliminate potential guesswork by clinicians routinely inundated with new data and oncology research. We created an ecosystem of treatment options, customized to the Cancer Treatment Centers of America standard of care, for patients to review and choose from that’s safe and efficient.”

    Twitter: @SiwickiHealthIT
    Email the writer: bill.siwicki@himssmedia.com


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    The Office of the National Coordinator for Health IT announced the Phase 2 winners of the Move Health Data Forward Challenge at HIMSS17 this past week. Awarded $20,000 each, the five winning groups will now move on to final phase challenge – which seeks new applications enabling individuals to securely share their own health information with caregivers.

    Phase 1 of the challenge called plans describing how applicants would develop tools to do that. Ten winners were awarded $5,000 and moved on to Phase 2, which requires the demonstration of a viable solution to achieve those goals.

    The winners of Phase 2:

    CedarBridge Group LLC. Its CareApprove smartphone app allows patients to grant (or revoke) permission for providers to access, send or receive their health data. Providers can use the CareApprove software plugin with their electronic health record system to stay connected with their patients through the CareApprove mobile app, communicating with each other through a secure messaging system.
    EMR Direct. Its HealthToGo too facilitates deployment of apps capable of leveraging multiple data sources in consumer mediated health data exchange – minimizing the number of identities to maintain and grant data to store, allowing consumers to easily manage health data sharing, and improving the accessibility of patient health data while maintaining its privacy and security.
    Foxhall Wythe. Its Docket is a secure system for users to store and share data with trusted care professionals, eliminating the need for paper-based patient intake processes. It enables HIPAA compliance via its User-managed Access approach and end-to-end encryption, as well as interoperability using HL7's FHIR specification. Authorization is accomplished via QR code scan and an explicit OAuth 2.0 handshake.
    Live and Leave Well. This tool offers both a consumer mediated exchange of end of life plans; and creates a transportable package of data that can be scored for goodness and shared with multiple systems using a combination open APIs and direct integration.
    Lush Group. Its HealthyMePHR system offers patients the ability to share and authorize access to their EHRs. Its resource server provides HEART-enabled data, an authorization server to support patient policy, and a client to allow authorized users to view a patient's records.

    Phase 3 of Move Health Data Forward will award $50,000 for as many as two winners, based on their ability to implement their tools via mobile or web-based apps.

    [Also: ONC names Phase 1 winners of Move Health Data Forward Challenge]

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


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