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Articles on this Page
- 03/22/17--11:54: _VistA replacement o...
- 03/22/17--12:08: _HL7 publishes a new...
- 03/23/17--13:18: _AMA, MGMA and 85 ot...
- 03/24/17--07:40: _MidMichigan to go l...
- 03/24/17--09:03: _Maury Regional Heal...
- 03/27/17--07:32: _Predictive analytic...
- 03/27/17--09:05: _Urology Austin rans...
- 03/27/17--12:06: _Carolinas HealthCar...
- 03/28/17--05:53: _Most Medicare patie...
- 03/28/17--10:37: _Patient engagement ...
- 03/30/17--04:01: _IBM Watson Health a...
- 04/10/17--05:50: _CIO Spotlight: EHR ...
- 04/10/17--10:14: _Industry groups pre...
- 04/11/17--07:21: _Paper or pixels? Cl...
- 04/11/17--12:33: _Tell us: How can EH...
- 04/12/17--05:28: _HL7 moves FHIR clos...
- 04/14/17--08:49: _EHR player NextGen ...
- 08/28/13--08:29: _Imaging Portals: Dr...
- 12/03/13--10:13: _EHR Insider's Guide...
- 12/03/13--10:19: _EHR Replacement: Do...
- 03/22/17--12:08: HL7 publishes a new version of its FHIR specification
- 03/24/17--07:40: MidMichigan to go live with $55 million Epic EHR on April 1
- 03/24/17--09:03: Maury Regional Health consolidates onto Cerner cloud-based EHR
- 03/28/17--05:53: Most Medicare patients haven't accessed their EHR information (yet)
- Lab results (by 94 percent of hospitals, 77 percent of doctors)
- Allergies (92 percent of hospitals, 81percent of doctors)
- Current medications (92 percent of hospitals, 82 percent of doctors)
- Problems and conditions (91 percent of hospitals, 80 percent of doctors)
- After-visit summary (85 percent of hospitals, 77 percent of doctors)
- Immunization history (82 percent of hospitals, 67 percent of doctors),
- Let data scream
- Go as high fidelity with real data as fast as possible
- If Everything is Important, Nothing is
- Real data is truth
- Prototype like crazy
- Design is not a theoretical exercise
- Gantt charts are the illusion of management
- Prototypes aren’t the end; they’re the means
- What Interface?
- Let the ink, UI, and lines disappear
- Reduce the distance between users and content
- Forget the pretty pictures, help people do what they want
- Know thy Code
- You should be as familiar with code as design
- Make Things
- Don’t design it if you don’t know how it’s going to be built.
- 03/28/17--10:37: Patient engagement has more moving parts than many providers realize
- 04/10/17--05:50: CIO Spotlight: EHR optimization and the 3 pillars of health IT
- 04/11/17--07:21: Paper or pixels? Clunky EHRs have providers looking to the past
- 04/11/17--12:33: Tell us: How can EHRs be fixed?
- 04/12/17--05:28: HL7 moves FHIR closer to interoperability for precision medicine
- 12/03/13--10:13: EHR Insider's Guide: The Secrets of Optimizing your EHR
- 12/03/13--10:19: EHR Replacement: Do It Right - An eBook Guide to EHR Replacement
The U.S. Department of Veterans Affairs is currently assessing whether it will stay with its VistA electronic health record system and will make a decision by July, said VA Secretary David Shulkin, MD, on March 21.
Drawing on his experience in the private sector and several commercial EHR installations, Shulkin said during a Politico event in Washington that he is adamant not to rush the process and be backed into a set timeframe.
Currently, VA is in close contact with U.S. Department of Defense during its own EHR installation, and Shulkin said there is a lot to learn about DoD’s choice to use Cerner’s EHR and the change management processes currently underway; change management, he added, would consumer the bulk of VA’s budget for a commercial EHR.
Shulkin added at the Politico even that it was a "mistake not to have made a decision with the DoD at the time. I'm not saying which side made the mistake, but look, the VA knows who its customers are. They come from one source: the DoD. And so not to have an integrated platform and records, I think, was a strategic mistake."
That said, the VA is also evaluating plans to modernize VistA before the final decision and Shulkin insisted he is not basing solely on finances.
The VA won't necessarily pick a particular vendor by the self-imposed July deadline but Shulkin said it will have a clear vision for moving forward at that time.
A new release of FHIR, the fast-spreading interoperability spec developed by HL7, was published on March 22, drawing on the work of hundreds of healthcare and technology professionals.
In a blog post on the HL7 website, FHIR Product Director Grahame Grieve said the Release 3 trial use specification aimed to address improvements related to implementation experience, alignment with other interoperability standards and internal quality review processes.
Among the changes that will be most useful to healthcare providers, he pointed to more support for clinical decision support and quality measures and better functionality to cover certain clinical workflows.
On the technical side, Release 3 features more robust development of terminology services and support for financial management, he said. In addition, it defines a RDF (resource description framework) format, and describes how FHIR relates to linked data. It also features a more mature RESTful API and conformance framework, as well as assorted other incremental improvements.
"The FHIR specification is very much the living record of the community of users who share the experience of trying to solve problems with it," said Grieve.
HL7 also published the first release of its U.S. Core Implementation Guide on March 22. It's meant as a base profile for FHIR use cases in this country, and should serve as a framework for other guides from ONC and others to build upon.
At HIMSS17 this past month HL7 member Micky Tripathi touted the value of such guides. If interoperability standards like FHIR are "ingredients," he explained, an implementation guide is akin to "cookbook" explaining how they can be put to work.
The American Medical Association, the Medical Group Management Association and dozens of other healthcare organizations have called on that the federal government reduce the burden and penalties associated with EHRs, meaningful use, the Physician Quality Reporting System and Value-Based Payment Modifier.
"We urge the Administration to take a series of steps to address challenges in MU, PQRS and VM prior to their replacement by MACRA and minimize the penalties assessed for physicians who tried to participate in these programs," they wrote in a letter to newly-confirmed Centers for Medicare and Medicaid Services Administrator Seema Verma. "As directed by the 21st Century Cures Act, CMS must establish a strategy to relieve the electronic health record documentation burden."
The groups recommended that CMS create a new category within the existing hardship exemptions specifically for administrative burdens, not penalize eligible providers because of “arbitrary ‘check the box’ requirements” under meaningful use, and offer relief for providers impacted by these programs that predate MACRA. They also called for hardship exemptions for PQRS and the VBPM.
"As indicated in the MACRA law and final regulations, policymakers in Congress and the Administration clearly understand that fair and accurate measurement of physicians’ performance will not be possible until better tools become available," the groups wrote. "We also believe the steps we have outlined are in keeping with President Trump’s efforts to reduce regulatory burden."
In addition to AMA and MGMA, the American Academy of Family Physicians, American College of Physicians, American Psychiatric Association, the Medical Society of the District of Columbia and 43 state medical societies were among those singing the letter to CMS.
After more than a year of preparing, MidMichigan Health has set a date for its go-live with an Epic Systems EHR that will connect five of its six medical centers, doctors’ offices and outpatient care facilities.
MidMichigan Health, which is affiliated with the University of Michigan, pegged the cost of the project at $55 million and officials noted that the new EHR would replace multiple vendor systems that required maintaining many custom interfaces, which had become unsustainable. As such, registration, scheduling and billing will also be on the same Epic platform.
“When we go live on April 1, we’ll have more than 750 staff designated as super users who will offer support to those using the new system,” MidMichigan Health CIO Dan Waltz said in a statement. “Our previous system showed us that we had a real opportunity to transform the way patient care is delivered. We’ve reviewed and incorporated best practices into the design of the system and have no doubt this EMR will give our patients all that they deserve and more.”
Waltz said more than 160 MidMichigan and Epic staff “worked around the clock” preparing for the rollout.
“The benefits of the new EMR to our patients are numerous,” Pankaj Jandwani, MD, chief medical information officer at MidMichigan Health, added. “Anywhere the patient goes within our system, a MidMichigan provider will have access to their full medical record.
Jandwani added that the new EHR would enable patients to do many more things electronically, such as schedule appointments online, self-check-in from home or at on-site kiosks, take advantage of virtual care options such as telemedicine and e-visits, and view and pay all MidMichigan Health bills from one account.
A second phase of the rollout will connect MidMichigan Medical Center in Alpena, Mich. in September 2017, and MidMichigan Home Care in the spring 2018.
Maury Regional Health in Columbia, Tenn. will roll out an EHR system from Cerner across three hospitals and more than 25 outpatient locations.
Maury Regional said it is replacing the existing Meditech EHR in its hospitals and NextGen in the ambulatory locations with Cerner Millennium. The Cerner EHR and integrated revenue cycle management solutions combine clinical and financial information within a single platform.
Through its remote-hosting offering, Cerner will manage and support Maury Regional’s EHR and deliver clinical data from its Kansas City-based data center.
“Cerner will provide our organization with enhanced capabilities that will be beneficial for providers and patients,” Maury Regional Health CEO Alan Watson said in a statement. “We are excited to unveil Cerner’s integrated health IT platform that will support our care teams across the continuum and unleash the potential of sophisticated functionality.”
Maury Regional will also adopt Cerner Transaction Services. The services provide recommended practice workflows across Cerner revenue cycle management solutions to prevent redundant tasks and manage manual intervention.
That dense pile of unstructured data may look like an impenetrable universe, but upon closer examination, the mammoth mass of of raw information holds insights that can greatly benefit healthcare. It comes down to identifying logical patterns within the chaos and extracting them for analysis, experts say.
As data analytics progresses, researchers are learning more about how to harness the massive amounts of information being collected in the provider and payer realms and channel it into a useful purpose for predictive modeling and population health management as well as for a multitude of clinical and administrative functions.
Paul Bradley, chief data scientist at Louisville, Kentucky-based ZirMed, jokingly refers to riding "a geek surfboard" in his job of probing healthcare's data tsunami. But his job is the equivalent of finding meaningful droplets within that tidal wave. The scope of that task is intimidating, but it is within these microscopic segments that meaningful discoveries are made.
ZirMed is working with providers in various stages of predictive analytics adoption and Bradley sees the larger health systems benefitting the most at this point.
"They have the raw material and the EHRs collecting the information, so it comes together," he said. "Predictive analytics takes the data and finds opportunities based on patterns and trends. It finds pockets of revenue by studying the granular level."
Patient-physician encounters can have thousands of attributes available for analysis from a billing perspective, services rendered and medications prescribed. Once the data set is prepared, ZirMed applies predictive modeling through charge integrity to extract patterns or trends.
"If an orthopedic surgeon uses certain bolts or plates to repair a joint along with specific drugs, there is a profile that can be created," Bradley said.
The more granular descriptions within ICD-10 has also helped zero in on missed revenue opportunities, he said.
"Missing just 1 percent to 2 percent of charges on claims in big health systems can come out to millions of dollars a year," Bradley said. "Across the spectrum, our clients have seen ROIs of four- or five-to-one."
Getting lingual with it
Natural language processing is another application that explores the contents of unstructured data and turns it into structured data for actionable insights. Boston-based Linguamatics focuses on converting "speech to text and turning that text into knowledge," says Simon Beaulah, senior director of healthcare.
The unstructured text of EHRs and literature in the life science domain are also sources of extraction, with Beaulah using ejection fraction as an example.
"If ejection fraction is less than 45 percent in the left ventricle of a poorly performing heart, that is a really important measurable value that indicates a serious disorder and is in the clinical notes," he said. "The reference to the ejection fraction needs to be identified – EF or Multiple EF. Once found, it can be extracted and turned into a discreet data element and applied to the overall congestive heart failure population to determine the appropriate treatment. The same can be done for pulmonary function in COPD or cancer staging and is very important in determining outcomes."
Without this technology, the process requires a manual chart review and reading through reams of notes to track down the "trapped information," Beaulah said.
Welcome to the machine
With all the attention artificial intelligence/machine learning is getting, Gurjeet Singh cautions that the public "underestimates where it is and overestimates where it will be."
What it will be, says Singh, CEO of Palo Alto, California-based Ayasdi, is a technology that accelerates data cultivation without human interference. (Where it won't be, he adds, is the worst-case scenario of machine self-awareness in The Terminator film series.)
Already in use by the world's biggest banks, Ayasdi's machine intelligence platform ingests and processes large volumes of internal or third party data, then applies multiple machine learning, statistical and geometric algorithms to gain insight and predict the future. It got its start at Stanford University with the Human Genome Project, which through a $10 billion investment mapped out the first seven genomes in detail.
"The challenge started with how to handle large data sets," Singh said. "We didn't know what we'd find. What we realized was that people weren't asking the right questions in a complex data set."
Patient-provider interactions are complex data sets, but for defragging the massive cyber-lump "analytics aren't that useful," Singh said. "It's about building apps that go to the dashboard. The problem with analytics is that the people who do it are not the ones who use it on a day-to-day basis. We need to build apps for the professionals who can use it themselves."
In explaining machine intelligence's role in healthcare, Singh refers to four "notions": Discovery, prediction, justification and action. "Any intelligence system that embodies these four concepts will use data efficiently," he said.
The artificial intelligence advantage is the removal of human subjectivity from the equation, though machine logic alone is not enough – "it needs to go hand in hand with human guidance as well," Singh said.
Zip code mining
Quantifying healthcare has one thing in common with real estate: Location, location, location, says Dave Hom, chief evangelist for SCIO Health Analytics in West Hartford, Conn. Specifically, he says it comes down to the zip code as a fertile source of demographic information about patients.
"The zip code is the greatest predictor of health status than genetics or education," Hom said. "Zip codes show income levels for towns that have vulnerability to diabetes. Zip codes with lower incomes typically have lower education. The number of physicians is much lower in low income areas and the number of fast food places is higher. Healthcare needs to realize the value of the zip code."
Zip codes are rich sources of information about their residents – income level, education level, number of dependents, spending habits and other factors that can be critical to understanding a patient's ability to comply with physician orders, Hom said, adding that other social determinants like unemployment, crime, even weather patterns can impact behavior. Moreover, he said the four-digit zip code extensions can create even more finely detailed micro-profiles.
Understanding the zip code and how to layer it onto the data creates value in measuring patient risk and propensity to consume," Hom said. "For physicians being paid for outcomes, getting that data helps them understand the viability of the patient."
Just getting started
The analytics movement in healthcare is "at the beginning of the beginning" and Singh says he is "super excited about its potential…there are some things we can attack right away, but there is so much more. Hospitals have barely started collecting genetic information and it will become super impactful once we learn more."
For Beaulah, the future represents "more opportunities to improve care," pointing to behavioral health and its co-morbidities as an unexplored frontier of unstructured data.
Ultimately, analytics needs to reach a point where "systems are built for physicians to give care their way without the need to explain it," Bradley added. "It's a tall order, but the forces out there around the escalating costs of care and a boomer population that increasingly needs it will enable the right technology to be developed."
A Jan. 22 ransomware attack on Urology Austin, a healthcare provider with locations throughout central Texas, may have exposed 279,633 patient records.
Urology Austin began notifying its patients on March 24 that hackers may have accessed patient records that included names, dates of birth, addresses, medical information and Social Security numbers. Officials said there's a chance this data may have been compromised during the attack.
One interesting aspect is the age of the data stored on the network. One patient told local Austin network KXAN that he almost threw away the notification as he hasn't been a patient of Urology Austin in 20 years.
While officials said it was quickly notified of the breach and shut down the network, the hackers were able to encrypt the data stored on the servers. Urology Austin didn't pay the ransom and restored patient information from backups.
Officials are currently investigating the incident and are taking steps to improve security on the network. Employees were retrained in regards to suspicious emails, privacy and security, which suggests the attack stemmed from an employee responding to an infected email.
Affected patients will receive one year of free credit monitoring and can call the organization's call center with any questions.
In an industry populated with physicians burned out from technology and bemoaning too many clicks, healthcare organizations need to create a culture that believes IT will do more than just improve patient care. Electronic health records and other technologies need to help clinicians improve workflow.
For Carolinas HealthCare System, that meant first zeroing in on its nursing team.
CHS went live with a three-year optimization project in May 2016 to simplify the EHR in the acute care venue. The health system has used Cerner technology for over 10 years and needed to update the systems to make things easier and give nurses a hand in using the technology.
The goal? To reduce documentation, remove duplicate records and organize the tech in a user-friendly system.
"If you make things better for your nurse, you make things better for your patient," said Becky Fox, RN, Carolinas HealthCare assistant vice president and chief nursing informatics officer.
By leveraging nursing informatics, Carolinas Healthcare reduced documentation time for head-to-toe assessment by 20 percent, which is equivalent to about 35,000 working hours returned to nurses directed back to patient care.
Additionally, CHS saw a 14 percent improvement in on-time medication administration, equal to about 400,000 eliminated clicks within the EHR. In total, CHS eliminated 5.8 million nursing tasks and reduced clicks by 17.4 million - or three or more clicks per task.
CHS also improved the quality of each assessment with 10 new screening tools, which generated third-party annual costs savings of $60,000.
The organization automated a clinical decision support tool to better identify patients at-risk of deteriorating conditions, Fox explained. Now, when nurses collect medical history during admission, it uses EHR and that data to automatically evaluate the risk level of the patient using established criteria.
While the nurses can use their own judgement, the program is designed to catch patients that would usually fall through the cracks, she continued.
We used a lot of analytics to drive design, Fox said. We also had a great partnership with bedside nurses, nursing managers, IT and our vendors. It was a significant change for clinicians.
"That's what's valuable to us: The nurses feel the computer has their back," explained Fox. "Nurses now feel part of the care team because they see the work they do makes a difference for the patient's care. It's really helped out nursing team feel the technology is part of the team."
The project has also helped to facilitate a cultural change, said Fox. We've really considered how to assure our clinicians we're putting the best tools in their hands.
"We had bedside clinicians involved in every step, which helped us get to a point where everyone was excited for the change," said Fox. "It helped us move into the direction that we're an evolving healthcare organization that helps our clinicians always be the best.
"When you give nurses back time, it comes out in your quality outcomes," she continued. "And it helps nursing staff deliver better care to their patients."
The HITECH Act, part of the Stimulus Bill (officially, the 2009 American Recovery and Reinvestment Act, ARRA) invested $35 billion of U.S. taxpayer funds to incentivize healthcare providers (doctors and hospitals) to acquire and use electronic health record systems – EHRs.
Most providers have taken advantage of these financial incentives, so that EHRs are now part of mainstream medical practice and workflow among providers.
For patients, and particularly those enrolled in the government programs of Medicare and Medicaid, personal access to their personal data in EHRs has been largely elusive. While nearly nine in 10 doctors and hospitals have offered these patients access to their personal health information via EHR systems, only a fraction of patients have taken advantage of this service.
Only 30 percent of patients enrolled in Medicare and Medicaid plans have accessed their personal health data from doctors, and only 15 percent of these patients have accessed their health data from hospitals, according to the GAO report, Health Information Technology: HHS Should Assess the Effectiveness of Its Efforts to Enhance Patient Access to and Use of Electronic Health Information, written for members of the U.S. Congress.
This report was researched and written as a response to Congressional representatives requesting this information; the list of requesters included Lamar Alexander, chairman on the Committee of Health, Education, Labor, and Pensions (HELP) in the U.S. Senate; John Thune, Chairman of The Committee on Commerce, Science, and Transportation in the Senate; Michael Enzi, Chairman of the Subcommittee on Primary Health and Retirement Security (in HELP); and Senators Richard Burr and Pat Roberts.
The most common areas of information access included, in order of availability to patients:
Most providers believe that it’s helpful for patients to, in particular, review their lab values, current meds, allergies, immunization history, clinical history, and after-visit summary. Lower on providers’ perceived value for patient review are radiology images and clinician notes.
Perspectives of patients were also part of the GAO study, which were limited to interviews with 33 patients who were members of the Patients Like Me community. The interviews asked patients about their electronic health information access, challenges they encountered when trying to access their information, benefits they experienced, and improvements they’d like.
The GAO found older patients may be less likely to electronically access their health information compared with younger patients. Younger patients and people managing chronic conditions are most likely to demand access to their health information.
There are also design issues that patients face when trying to access their personal health information on provider portals, such as technical difficulties and confusing user interfaces.
Health Populi’s Hot Points: We’re all familiar with the Field of Dreams scenario from the movie about the baseball field, a mystic call to Shoeless Joe Jackson and other players to reunite on the holy ground: “If you build it, he will come,” a mysterious voice whispers. And, eventually, these baseball players do come to play.
This Field of Dreams effect isn’t so responsive when it comes to patients accessing their personal health information, even though most healthcare providers have installed EHR systems. I wrote about Xerox’s (now Conduent’s) fifth annual electronic health records survey back in December 2014, over two years ago, with respect to the Field of Dreams. Xerox notes that most patients were not yet using patient portals, with some generational differences. Among people who hadn’t used a portal, 57 percent felt they’d be more proactive and engaged in their healthcare if they did indeed access their health data.
This leads to how to design that baseball field – in this case, the patient portal. In fact, patients don’t tend to like “portals,” per se. People, however, like health, and they are keenly interested in their own lives. So, user-centered design must speak to peoples’ real lives, their values, their local social determinants of health, their life-flows…and not repeat online what a clinician’s EHR dashboard looks like.
Good design, like broadband, is emerging as a crucial underpinning for individual and population health. Start by getting smart on my treasured colleague Juhan Sonin’s Design Axioms for health information and engagement linked here. They include:
Perhaps begin with the last, #16: That’s about the users – patients, persons, consumers, caregivers. It’s about their life flow and values. And eventually, “let data scream!”
While the healthcare industry by-and-large understands the importance of patient engagement in the service equation, setting up a system that empowers patients and gives them more control of the care process has been, for the most part, elusive.
Perhaps it is due to all of the moving parts of hospital workflow, relationships with post-acute providers that are still emerging and a complex customer dynamic that spreads across both provider and payer horizons.
Keeping the patient engaged amid a chaotic scheduling, clinical and financial environment is indeed a challenge. But technology companies are making inroads toward better patient engagement by targeting specific episodes and encounters in the vast healthcare continuum and it appears to leading to an improving climate of patient satisfaction and rapport with providers.
Through a commitment to developing mobile device apps that tap into the machinations of healthcare provider organizations, companies like Panama City, Fla.-based Jellyfish Health are giving patients new tools for managing their episodes of care and any chronic conditions they may have.
"We focus on the patient experience from the outpatient side – ambulatory surgery centers, physician clinics, labs and other post-acute sites," said Jellyfish CEO Dave Dyell. "It starts with patient scheduling all the way through until check out. While clinician interaction is a major part of the experience, it is the non-clinical touch points that harm the experience.
"Most patients are happy with the care they receive, but they won't come back if they waited too long to check in or spent too much time in the waiting room. Our app ensures they have the opportunity for a positive encounter," he added.
Founded two years ago in the population health space, Jellyfish sharpened its focus on individuals managing their own health – a concept with promise if they could more easily navigate the labyrinth of obstacles in making appointments, cutting through insurance coverage snafus and optimizing their time spent at healthcare facilities, Dyell said.
The cloud-based Jellyfish app organizes how to navigate the provider landscape, anticipates workflow bottlenecks and keeps users up to date on their appointment status.
"It provides transparency in the healthcare experience," Dyell said.
As if adult patient engagement wasn't tricky enough, pediatric engagement adds another layer of complexity with the family support network. Bethesda, Md.-based GetWellNetwork aims to include everyone involved in the pediatric patient's circle of care, said Shannon O'Neill, vice president of pediatrics.
"When you think of how healthcare is delivered, the focus is on clinical workflows and pathways," she said. "Our software is a way to engage families in the process. It is a cross-continuum platform that includes the patient and family-facing piece to the care puzzle."
It is the family dynamic that makes pediatric care special, O'Neill says. The blended families of today often consist of more than two parents located in different places, but who are actively involved in a child's care.
The key to effective pediatric engagement, O'Neill says, is empathy with patients and their families.
"Providers have historically had good data, but they haven't had the patient voice," she said. "Understanding the true voice of the patient is where you can affect the engagement process. Getting their perspective is an important piece of the puzzle."
Chronic kidney disease is a serious disorder that is not well known within the usual spectrum of disease state management, at least when compared to the more common conditions of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease and asthma. Therefore, a diagnosis often catches patients by surprise and can come as a shock to the system, acknowledges nephrologist Carmen Peralta, MD, chair of San Francisco-based Cricket Health's Medical Advisory Board.
"What commonly happens is a patient gets sent to me because the primary care physician is concerned about abnormal kidney function, and even though they show no overt symptoms, they are seriously ill," Peralta said. "If they have advanced kidney disease, this is the first they've heard about it and it is very hard news to take. The worst part is when I go into their electronic health record and see that kidney function has been in decline for a decade and nothing was done about it."
If a patient reaches end-stage renal disease, there is no time for effective engagement, she said. Therefore, she advocates public awareness campaigns are crucial to educate society about the seriousness and commonality of chronic kidney disease.
Patients with less advances stages of the disease do have an opportunity for engagement and preventive measures, such as low sodium diets and regular monitoring of creatinine levels.
Peralta concedes she had never worked with a technology company on developing an app before and the challenge was determining what to do once it is detected.
"Their life is turned upside down – they need to learn," she said.
Cricket developed content in multiple forms – videos, online content for reading and user chat with patients who live with kidney disease.
"The people behind this technology are determined to help these patients know they are not alone," Peralta said. "It provides invaluable support about living with the disease."
The payer piece
Patient engagement also has a third component in the form of handling payment arrangements with the insurance companies. It is the wheelhouse of Centerville, Ohio-based PayorLogic.
Coming at the back end of the patient engagement process, reconciling co-payments and deductibles for services can be a multi-faceted source of confusion, especially for emergency room visits and inpatient stays, contends Tyler Williams, president of PayorLogic.
Misunderstandings about how much is owed "makes everyone look bad and makes the patient angry," he said.
Blame can be cast around to all parties, though Williams says patients need to be better versed at the information they need to give and providers must commit to a system that ascertains the correct profiles at intake, where 40% of errors are made.
"We used to work the back end to clean up messes – we would scrub to verify the patient demographic and ensure that all information was correct," he said. "But six months down the line it may not be right and suddenly the patient is getting bills from everywhere. So we built some real-time solutions for pre-registration at emergency or non-emergency and use third-party credit data to confirm. Any discrepancies are found, corrected and patient satisfaction goes up exponentially."
Getting up to speed
While technology is facilitating the growth of patient engagement, the healthcare industry still has a long way to go in empowering patients to take control of their health, chronicle their experience and synchronize with providers and payers, said Jean Drouin, MD, CEO and co-founder of San Francisco-based Clarify Health.
"Healthcare workflows remain broken and there is no such thing as a 21st century service experience," he said.
As "very much an optimist and pragmatic idealist," Drouin is promoting UPS and FedEx tracking systems for real-time patient engagement practices.
"What we see is a couple fundamental trends that may finally lead providers to make the same sorts of investments that Amazon, UPS and Fedex make today in analytics and workflow optimization platforms," Drouin said. "We strongly believe that with advent of new risk-based payment models, the provider are assuming risk, leading to a greater desire among the forward thinkers to invest in the kind of systems to be competitive."
IBM Watson Health will adopt SNOMED CT for use in Watson Health work, SNOMED International and IBM Watson announced Thursday.
SNOMED CT is an international standard for clinical terminology. It makes possible the global exchange and analysis of clinical information in electronic health records through a codified language that represents groups of clinical terms.
SNOMED International, a nonprofit organization, owns and develops SNOMED CT.
“SNOMED’s agreement with IBM Watson Health breaks new ground,” said SNOMED International CEO Don Sweete, in a statement. “Imagine the impact of feeding SNOMED CT’s 325,000-plus concepts into Watson’s cognitive capabilities. The possibilities for clients, and the healthcare industry in general, are almost limitless.”
More than 30 countries have adopted SNOMED CT, and it's actively used through agreements with 5,000 affiliates, such as healthcare payers, medical libraries and biopharmaceutical companies. SNOMED CT has extended the reach of its vast collection of structured clinical concepts over several years, Sweete noted.
“SNOMED CT presents clinically relevant concepts and modifiers consistently and comprehensively, providing a global language of healthcare,” Lisa Rometty, vice president of global markets for IBM Watson Health, said in a statement.
She added that standardizing offerings with SNOMED CT helps IBM provide customers and collaborators with clear and current information, which in turn help clinicians as they weigh clinical options.
Baystate Health CIO Joel Vengco talks with Healthcare IT News about applying the three pillars of IT to healthcare, as well how his organization has focused on optimizing their legacy EHR rather than replacing it.
The U.S. Department of Health and Human Services should provide technical assistance to private-sector led initiatives that promote patient safety by accurately identifying patients and matching them to their health information, 25 industry groups have informed members of Congress.
Allowing the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services to offer this type of technical assistance will help scale safe and effective patient matching solutions, the industry groups, including HIMSS, said in their April 5 letter to the chairmen and ranking members of several House and Senate committees.
“For nearly two decades, innovation and industry progress has been stifled due to a narrow interpretation of the language included in Labor-H bills since FY1999, prohibiting the Department of Health and Human Services from adopting or implementing a unique patient identifier,” the organizations wrote in the letter.
The lack of a consistent approach to identifying patients has resulted in significant costs to hospitals, health systems, physician practices and long-term post-acute care facilities. This lack of consistency has also hindered efforts to facilitate health information exchange, the organizations said.
"HIMSS for several years has urged Congress to address the impact of the UPI," said Thomas M. Leary, vice president of government relations at HIMSS. "This report language would mark a recognition by Congress of the need to remove barriers to HHS engaging with the private sector to develop a coordinated national strategy to improve the accuracy and efficiency of patient data matching."
Misidentification costs the average healthcare facility $17.4 million a year in denied claims and potential lost revenue, according to a survey of healthcare executives in the 2016 National Patient Misidentification Report from the Ponemon Institute. What’s more, 86 percent of these respondents said they have witnessed or know of a medical error that was the result of patient misidentification.
The 25 industry groups’ solution to this problem is to include new language in the forthcoming House FY17 Labor, Health and Human Services, and Education and Related Agencies draft Appropriations Bill.
“The Committee is aware that one of the most significant challenges inhibiting the safe and secure electronic exchange of health information is the lack of a consistent patient data matching strategy,” the groups said. "With the passage of the HITECH Act, a clear mandate was placed on the Nation’s healthcare community to adopt electronic health records and health exchange capability. Although the Committee continues to carry a prohibition against HHS using funds to promulgate or adopt any final standard providing for the assignment of a unique health identifier for an individual until such activity is authorized, the Committee notes that this limitation does not prohibit HHS from examining the issues around patient matching. Accordingly, the Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology and CMS, to provide technical assistance to private-sector led initiatives in support of a coordinated national strategy for industry and the federal government that promote patient safety by accurately identifying patients to their health information.”
This language clarifies Congress’ intent while ensuring that the government does not hinder private-sector efforts to solve this problem, the groups said.
The 25 industry groups that signed the letter include the American Academy of Family Physicians, American Medical Association, America’s Health Insurance Plans, American Health Information Management Association, American Medical Informatics Association, Association of Clinicians for the Underserved, College of Healthcare Information Management Executives, Confidentiality Coalition, Connected Health Initiative, Electronic Healthcare Network Accreditation Commission, Healthcare Leadership Council, Healthcare Information and Management Systems Society, Health IT Now, Imprivata, Intermountain Healthcare, LeadingAge - CAST, Long Term and Post-Acute Care Health IT Collaborative, Medical Group Management Association, National Health IT Collaborative for the Underserved, Nemours Children’s Health System, Pharmaceutical Care Management Association, Premier Healthcare Alliance, Strategic Health Information Exchange Collaborative, The Sequoia Project, and Trinity Health.
Now that the EHR boom has moved healthcare into the software age, clinicians complain that electronic health records take the joy out of medicine, distracting them from treating patients and eating up time with unpaid tasks.
But while providers aren’t exactly pining for the days of paper records, there is some debate about electronic health record platforms being the most effective way of practicing medicine.
What happened to user-friendly?
Many people blame the HITECH Act and its meaningful use EHR program for incentivizing software vendors to craft products that meet the federal government’s specific criteria at the expense of innovative features and functionality.
But when it comes to record-keeping, physicians have documented or dictated patient notes for some time. The routine practice was often conducted after normal workday hours -- either through dictation, written notes, or a combination of both.
But paper inherently limited how doctors could use patient records, notes, and any data tied to them, nevermind the seamless and real-time health information exchange the industry is striving toward now.
“Searching the paper chart was impossible. The writing was often illegible and while today’s copy and paste is appropriately maligned, being able to import pieces of yesterday's note and modifying it from there saves a lot of time,” said Robert Wachter, MD. “While I'm unhappy with the EHR, I wouldn't go back to paper. Nor would my colleagues.”
Count Charles Webster, MD, among those. The president of EHR Workflow said that incentive-driven mandates, notably meaningful use and MACRA, have essentially pinned down the current crop of EHR technology from significant advancements.
“Most physicians today would not go back to pre-EHR days,” Webster said. “But many who had EHRs before meaningful use would definitely go back to pre-MU days.”
Stuck in the middle
There was a time when hospitals developed their own EHRs and employees loved them.
“In the ambulatory medical practice world, some physicians wrote personal checks for their EHRs,” Webster said.
They wouldn’t have done so if they thought the software was useless.
“In many cases, EHRs that were designed pre-MU, and originally had high user satisfaction, were redesigned to obtain MU subsidies and, subsequently, user satisfaction dropped,” Webster said.
Even health systems eschewing meaningful use, such as Intermountain Healthcare, cannot go back to the days before MU. The program has been running for nearly 8 years, the government spent approximately $35 billion on it, and almost the entire industry is using some sort of EHR now.
That leaves hospitals and IT shops essentially waiting for meaningful use to end and, ideally at least, pave the way for software vendors to ratchet up the competition based on features and functionality rather than merely meeting government criteria in the next generation of EHRs.
Health execs aren’t powerless
Webster said the industry’s ability to improve the current installed base of EHRs is limited. He suggested instead implementing a new layer of workflow technology on top of “the existing layer of workflow-oblivious databases with lousy user interfaces.”
Wachter added that healthcare executives should ensure they have adequate clinician-informatics on staff to bridge the chasm between any vendor-built system and front-line clinicians.
He also suggested instituting a program that involved IT people spending several weeks entrenched with actual EHR users -- as UCSF did a few years after implementing Epic -- to understand the challenges, tweak the software accordingly, and re-train users to take full advantage of the EHR.
Webster also advised that healthcare's “boil-the-ocean” approach to data and physician micromanagement needs to stop. “Stop directly incenting outcome measures,” Webster said, citing Goodhart's Law.
“When a measure becomes a target, it ceases to be a good measure."
As new reports highlight how electronic health records are distracting doctors from treating patients, Healthcare IT News is exploring the next steps needed to fix these pivotal tools.
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Health Level 7 took another step forward with its FHIR specification this week by publishing the first HL7 Domain Analysis Model: Clinical Sequencing.
In addition to precision medicine, the developing FHIR specification is widely viewed as a boon to population health and data interoperability, albeit one that will have to live alongside other standards for some time.
The new Domain Analysis model, or DAM as HL7 abbreviates it, comes on the heels of Release 3 of FHIR, which included FHIR Genomics
“FHIR Genomics enables institutions to more quickly move toward precision medicine,” said Gil Alterovitz, a professor with the Harvard Computational Informatics Program and Boston Children’s Hospital who co-chairs the HL7 Clinical Genomics Work Group.
Tech-savvy hospital IT shops, standards makers, software developers and IT vendors can use the DAM to design interoperable solutions for genetics and genomics, HL7 said in the document.
The use cases that HL7 highlighted include clinical sequencing, including testing a patient’s germline genome, cancer and tumor profiling, neonatal testing, newborn screening and early childhood development delay, as examples.
“Each use case may include several scenarios where test results are manually translated from reports into either a tool for clinical decision making (e.g. family history or drug dosage calculator) or for public health reporting for cancer registries,” HL7 said.
Alterovitz added that the DAM was developed over the course of five years and was cited by National Institutes of Health Precision Medicine Initiative last year as a basis for building FHIR Genomics and Sync for Genes.
“The use cases are in practice somewhere, so others can adopt them,” Alterovitz said. “Today, not three or five or 10 years into the future.”
NextGen Healthcare Information Systems will buy cloud-based Entrada for $34 million in cash, the companies announced this week.
NextGen markets electronic health record, practice management, analytics, population health and other technologies, and Entrada’s mobile app integrates with multiple clinical platforms and all major EHRs, the company said.
Because of its mobile functionality and integration with clinical systems, Entrada’s system can become an important part of the daily clinical workflow for physicians and other users, the company added.
Entrada lost $2 million in 2016 on revenue of about $12 million, the company said.
“Mobile health solutions – in the palm of the provider – are quickly becoming some of the most valuable real estate in healthcare,” said Rusty Frantz, president and CEO of NextGen Healthcare. “We intend to invest in expanding Entrada’s capabilities, continuing to provide enhancements to their already impressive platform. This acquisition will improve physician satisfaction by providing a better caregiver and patient experience while enabling clients to improve financial outcomes.”
Entrada is focused on improving clinical workflows and creating opportunities for additional provider and patient engagement, said Entrada CEO Bill Brown.
Earlier this year, NextGen Healthcare’s enterprise practice management software was named the most improved physician practice product by KLAS.