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    Healthcare IT News
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    NextGen
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    Cerner is the best vendor candidate to replace the U.S. Department of Veterans’ Affairs proprietary VistA, according to a new Black Book report.

    VA Secretary David Shulkin, MD, announced last month it would make a final decision in July on whether it will keep VistA or replace it with a commercial EHR. However, Shulkin is a vocal proponent for moving to a commercial EHR.

    The VA sent two RFIs on April 12, seeking information from vendors about commercial off-the-shelf options and cloud-based options, as well as how to modernize VistA by stitching together multiple platforms.

    [Also: Paper or pixels? Clunky EHRs have providers looking to the past]

    To determine the best replacement, Black Book surveyed 30,000 EHR users and analyzed 24 key performance indicators (KPIS) for the five leading EHR vendors: Epic, Cerner, Allscripts, Meditech and athenahealth. It ranked vendors on which best helped combat the opioid crisis, improve care access, satisfaction, engagement and delivery, innovation of government agencies and government performance and fiscal improvement.

    Cerner topped the list with an average score of 9.14 of a possible 10 across all categories and 24 KPIs. It also topped all categories.

    Cerner outperformed in technology function to support providers attempting to combat the opioid crisis and scored highest in drug surveillance tools and prescription record tracking, behavioral health and addiction EHR capabilities. It also scored highest in IT outsourcing and privatization capabilities, tech support, hosting, interoperability and cybersecurity.

    Allscripts came in second with a score of 8.91, finishing behind Cerner in all categories. Epic had a mean score of 8.17, athenahealth scored 7.89 and Meditech scored 7.66.

    Black Book said that cost control, go-lives and improving client’s fiscal performance are Epic’s weakest areas. 

    [Tell us: How can EHRs be fixed?]

    All of the ranked vendors scored about 7 in all KPIs and the first three categories except Meditech, which scored a mere 5.79 in patient portal and experience.

    For some vendors, meeting the demands of improving government performance and fiscal improvement was the weakest area. Meditech scored 6.85 and Epic scored 6.75 here. However, Epic’s greatest weakness was improving the client’s fiscal performance (5.77).

    athenahealth struggled with ERP and supply chain support (6.68) and vendor reputation, trust and viability (6.25).

    VistA is over 30 years old and serves more than 1,200 Veterans Health Administration healthcare sites. It’s long been criticized by Congress for its failure to modernize and become interoperable with the Department of Defense’s EHR. DoD uses Cerner for its EHR. 

    Black Book managing partner Doug Brown, however, noted that VistA was a pioneer and the basis of many of today's commerical EHR architectures. 

    “Three of the companies represented in our Black Book report are taking inspiration from the spirit of VistA, even as they vie to replace it,” Brown added. “Cerner, Allscripts and Epic recently indicated they intend to make EHRs more open, utilizing application programming interfaces to enable third-parties to write apps for their platforms.” 

    [Also: Doctors demand extreme EHR makeover ... right now]

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


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    http://pages.healthcareitnews.com/The-Digital-Hospital---Technology-for-Better-Care-Delivery.html?topic=ehr%2C%20informationtechnology%2C%20workflow
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    In a digital hospital, care delivery is revolutionized using state-of-the-art technology to create seamless, integrated communication between patients, practitioners and the hospital IT systems.


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    http://pages.healthcareitnews.com/Do-More-with-Less-with-Distributed-Capture-POC-Scanning.html?topic=ehr%2C%20imaging%2C%20informationtechnology
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    Hospitals across the nation are asked to Do More with Less, Save Money, Maximize Efficiency, Achieve HIMSS 7, and perform their day job all at the same time. With Distributed Capture Point of Care Scanning, these are only a few of the possibilities.

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    While it would appear obvious that any EHR downtime or outage would pose a significant threat to patient safety, a new survey suggests that is not the case in all countries.

    Sermo, the social network for physicians, polled its international members and found that more than half indicated such an electronic health record malfunction has never jeopardized patient safety.  

    That holds true among developed nations with public healthcare systems, including Canada, England, France and Germany, according to Sermo.

    But that’s not so in the United States, where a majority of physicians indicated that EHR downtime has created health and safety issues for patients.

    There’s a caveat, though: 1,678 of the total 3,086 respondents were in the United States, representing the biggest concentration of respondents.

    The United States was not the only country among the 26 Sermo polled where more respondents suggested problematic EHRs create safety issues. Physicians in Denmark, Greece, Hungary, Poland, South Africa answering “yes” to the question outnumbered those saying “no,” though the number of respondents was very low.

    Norway, meanwhile, saw an even split with one doctor answering in the affirmative and the other in the negative.

    Here are the results:

    Has an EMR/EHR outage or malfunction ever jeopardized the health or safety of a patient?

    Country Yes No Number of respondents
    Argentina 30% 70% 23
    Australia 31% 69% 39
    Austria 33% 67% 6
    Canada 46% 54% 82
    Colombia 33% 67% 9
    Denmark 100% 0% 2
    Finland 0% 100% 1
    France 39% 61% 127
    Germany 9% 91% 92
    Greece 64% 36% 28
    Hungary 100% 0% 2
    Ireland 0% 100% 1
    Israel 0% 100% 2
    Italy 29% 71% 337
    Mexico 37% 63% 147
    Netherlands 33% 67% 9
    Norway 50% 50% 2
    Poland 63% 38% 16
    South Africa 85% 15% 20
    Spain 33% 67% 292
    Sweden 0% 100% 3
    Switzerland 0% 100% 2
    United Arab Emirates 0% 100% 1
    United Kingdom 46% 54% 106
    United States 55% 45% 1678
    Venezuela 37% 63% 59
    Total 46% 54% 3086

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com


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    As the U.S. Department of Veterans Affairs weighs replacing its home-grown VistA EHR with a commercial electronic health record platform, at least one expert hopes the federal agency will pick any other vendor but Cerner.

    "Choosing another vendor besides Cerner may actually force leading industry EHR vendors to truly address interoperability at a far deeper level than what has been done to date," said Chilmark Research founder John Moore.

    [Also: Black Book: Cerner is best EHR to replace VA's VistA]

    The VA is in a unique position right now to advance health information exchange and interoperability not only with the Defense Department but, even more important, with the healthcare industry at large. 

    With the DoD’s massive Cerner EHR early-stage pilot testing underway, it is tempting to think that Veterans Affairs could also adopt Cerner and ultimately integrate data of all the patients both agencies serve. 

    Black Book, in fact, ranked Cerner as the best vendor candidate to replace VistA. But choosing Cerner might not be the interoperability fix it appears to be. 

    The VA is poised to spark real change with current interoperability issues facing the entire healthcare industry, but if goes with Cerner it will miss that opportunity to fix cross-vendor interoperability, said Moore. 

    [Also: Tell us: Which commercial EHR should the VA pick to replace VistA?]

    Beth Israel Deaconess Medical Center CIO John Halamka, MD, also said that VA and DoD have an opportunity to “drive standards-based interoperability not through regulations but through market action.”

    But such thinking would be a new path for VA, which doesn’t typically engage in the same sort of interoperability discussions that the Office of the National Coordinator for Health IT drives. 

    VA, however, is no stranger to interoperability and it grapples with the need to exchange records with the private providers and specialists that treat a significant portion of its patient population. So it does stand to benefit as interoperability increases among various hospitals, practices, networks. 

    “Deploying industry-standard interfaces and APIs and actively participating in ‘retail’ commercial exchange such as CommonWell and Carequality will do more to advance interoperability than any amount of ONC ‘enhanced oversight,’” Halamka said.

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


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    HIMSS Analytics on Friday revealed updated criteria for achieving Electronic Medical Record Adoption Model certification in 2018.
     
    “It’s both evolutionary and a big change. We’re not taking any criteria away but now we’re adding to it,” said HIMSS Analytics Global Vice President John Daniels. “EMRAM is a truly aspirational model.”
     
    Effective January 1, 2018, the new EMRAM criteria brings a first-time focus on privacy and security and moves the PACS and digital imaging requirement from Stage 5 down to Stage 1. 

    [Also: Saint Francis Hospital scores HIMSS Stage 7 Award]
     
    That means that hospitals vying for Stage 1 need to have PACS for DICOM and patient-centric storage of non-DICOM images.

    The security requirements begin in Stage 2, with a look at data center security, end-user training, encryption and disposal policies as well as antivirus, anti-malware and firewall programs.
     
    Stage 3 requires role-based access control and intrusion detection and Stage 4 stipulates that clinicians can access data about patients’ allergies, diagnoses, medications and recent labs in the event that systems go down. 

    New to Stage 5 is the requirement that hospitals have intrusion detection systems and portable device security.

    [Also: Saudi Arabia hospital achieves HIMSS Analytics Stage 7 EMRAM]

    Hospitals looking to achieve Stage 6 will need to have security risk assessments in place and any organization aiming for Stage 7 will need to provide an overview of its privacy and security program.
     
    Daniels said that HIMSS Analytics is also adding non-scored criteria to Stage 7 for anesthesia information systems in operating rooms and the use of smart pumps that interface bi-directionally with EMRs.
     
    “We’re going to ask about these capabilities because we anticipate they will become part of the criteria in five to 10 years,” Daniels said. “We’re letting the market know that in the future these will be required.”

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com


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    When it comes to whether the U.S. Department of Veterans Affairs should replace its VistA EHR with a commercial product, our readers we nearly unanimous in their support, with the bulk of them picking Cerner over other top-shelf vendors.

    In a recent Healthcare IT News poll, about 51 percent of readers said Cerner should be the VA’s choice, which aligns with a recent Black Book report that said the same thing. But while 27 percent of readers said Epic would be the best choice, there’s no clear forerunner behind Cerner.

     

    VA Secretary David Shulkin, MD, announced in March that the agency will determine the future of its outdated VistA system by July.

    [Also: VA picks two vendors to standardize agency’s clinical decision support]

    Shulkin is a vocal proponent for ditching the platform and moving to a commercial EHR. And former CIO LaVerne Council has echoed those sentiments about the failed iEHR project VA and the U.S. Department of Defense attempted. The failure led to DoD replacing its homegrown EHR AHLTA with an initial $4 billion contract to Cerner, Accenture and Leidos.

    “From my understanding, there is currently limited interoperability with DoD system. If an EHR designed by Cerner would allow seamlessness between the two -- why not?” one reader said.

    The overwhelming number of respondents point to the need for the VA to focus on delivering care -- instead of attempting to develop and maintain and EHR system. One reader said the VA needs to “stop reinventing the wheel.”

    [Also: VA finally gets transparent on veteran wait times, clinical care quality]

    But what are the alternatives and benefits to keeping Vista?

    Some readers lean toward hiring outside help to outsource development and support, while others think VistA needs optimization of its interface. These options would save the VA a substantial amount of money.

    The VA should “hire seasoned architects and engineers with EMR experience to update it from the ground up,” one reader said. “Technical documentation writers could document every aspect of the system for continued support and maintenance.”

    Other readers suggested VistA should remain in place, while the VA can install other programs to support the system. For example, a commercial health interoperability and HIE platform will create a longitudinal record that spans over all VistA sites, while connecting with DoD and other commercial partners.

    “Even if the decision is made to replace VistA,” one reader suggested, “this platform would still be very applicable for data sharing and for industrial strength plumbing to fulfill the VA's Digital Health Platform strategy.”

    No matter the result of the July decision, it’s clear all are in agreement that change is imminent and necessary to fix a flawed system that could better serve veterans.

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


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    Healthcare technology giant Cerner plans to integrate its HealtheAthlete technology with NeuroLogix Technologies’ C3Logix concussion management system.

    Nate Hogan, general manager of HealtheAthlete, defines the technology as a cloud-based sports medicine and athlete health management system that enables providers to document injury, rehabilitation, conditioning and health-related events. The information can be accessed from a computer or mobile device almost anywhere, anytime, he adds, and the system also provides built-in tracking and analysis tools.

    “HealtheAthlete captures critical health data throughout the life of an injury, and our collaboration with C3Logix will help with the health and safety of athletes across high school, collegiate and professional settings,” Hogan said in a statement.

    Nearly 4 million U.S. athletes suffer a concussion every year, according to the Centers for Disease Control and Prevention, which claims that timely recognition and appropriate response is critical in treating a mild traumatic brain injury, and early diagnosis and management are key components.

    The C3Logix system, developed at Cleveland Clinic and commercialized by NeuroLogix Technologies, makes it possible for physicians, athletic trainers and other trained personnel to assess neurologic impairment.

    Athletes are given a series of tests at the beginning of the season to create a baseline. The same tests are given again when the athlete is injured to determine the extent of the injury.
    C3Logix also aggregates neurologic data over time to create comparisons that help medical practitioners determine the best treatment plan. Researchers also use C3Logix to collect longitudinal data, year over year, to help improve the understanding and long-term implications of concussions.

    “We have long needed to raise the bar in brain injury assessment, while leveling the playing field to provide better access to quality tools,” Jay Alberts, of Cleveland Clinic Lerner Research Institute, said in a statement. “Integrating data into a single athlete record will keep care teams from fumbling through multiple systems, duplicating data entry or worrying about the risk of missing information.”

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


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    The American Health Information Management Association late Friday called on Congress to fund the Office of the National Coordinator for Health IT and said not doing so would be a detriment to the bipartisan 21st Century Cures Act.

    “We urge you to maintain sufficient funding for ONC to meet its statutory obligations under the 21st Century Cures Act,” AHIMA CEO Lynn Thomas Gordon wrote in a letter to Sens. Patty Murray and Roy Blunt, ranking member and chair of the Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies in the U.S. Senate.

    [Also: The dawn of precision medicine has begun, ONC says]

    Gordon said that ONC plays a key role in a number of critical areas within health IT.

    The first is standards development to advance the interoperability of patient data among EHRs, personal health records, medical devices and other healthcare technologies. The second area is in convening all necessary stakeholders to create a Trusted Exchange Framework and the information governance to support that.

    Gordon also pointed to ONC as a federal partner involved with patient’s rights to access their data under HIPAA and otherwise.

    “We understand that Congress faces difficult choices in funding a variety of priorities with limited resources. However, failure to adequately fund ONC will undermine a major tenet of the Cures Act,” Gordon wrote.

    [Also: 21st Century Cures Act a boon to telehealth, experts say]

    And she cited an analysis of 21st Century Cures by the U.S. House of Representative’s Committee on Energy and Commerce of that tenet: “the delivery of new drugs and devices to the right patient at the right time by ensuring electronic health record systems are interoperable for seamless patient care and . . . [to] fully realize the benefits of a learning healthcare system.”

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com


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    Buffalo-based Erie County Medical Center is still struggling to bring its computer systems back online after a virus was discovered on April 9, according to The Buffalo News.

    The hospital was hit with a cyberattack, but hospital officials are declining to confirm the attack is ransomware due to the ongoing investigation. However, Buffalo News cited sources that said the attack was indeed ransomware.

    As ransomware can encrypt and shut down infected computers, it seems the most logical reason to why ECMC still doesn’t have systems online. Medstar, Hollywood Presbyterian and Appalachian Regional all remained down for days after ransomware attacks in 2016.

    [Also: Virus knocks Erie County Medical Center offline for days]

    ECMC has also said the investigation found no patient records have been compromised. Officials told Buffalo News the hospital website was back up and over 6,000 hard drives were cleared and returned to workstations. However, these computers have not been turned on yet.

    The hospital’s electronic health record is partially online but in view-only mode. ECMC’s emergency, ambulatory surgery, transplantation, dentistry and direct admission departments is using an electronic registration process. Financial systems are coming back online and employees are using temporary email.

    [Also: New ransomware spotted as targeting healthcare industry]

    This week, ECMC will work on establishing a new hospital email system, continue restoring the inpatient EHR system functions, reestablishing electronic communication with lab system, fixing the bed coordinating system and bringing the restored desktop computers back online.

    The week of May 1, the hospital will work on electronic transmission of radiological images, physician documentation, further rollout of restored desktop computers and continued restoration of the inpatient EHR.

    “Thanks to the hard work, dedication and tireless effort of the ECMC family, patient care continues to be delivered,” ECMC President and CEO Thomas J. Quatroche Jr. said in a statement. “Western New Yorkers continue to receive the quality health care services they deserve and have come to expect.”

    “Under the circumstances, that’s a strong testament to our caregivers’ commitment and the community’s trust in them,” he said. “We continue to make progress on restoring our computer system.”

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


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    Like all healthcare CIOs, Joel Vengco, chief information officer at Springfield, Massachusetts-based Baystate Health, has no shortage of pressing projects competing for his attention.

    Whether it's working to drive operational efficiencies across the $2.5 billion health system, improving the usability of an array of applications for clinical end users, spearheading community engagement and patient outreach for population health management or working on analytics and "knowledge management," it all make for a busy workday.

    That's all in addition to the imperative of constant innovation: Beyond just being Baystate's CIO, Vengco is the founder of TechSpring, an innovation center based at the health system where IT vendors are given secure access to real patient data to speed the development of new technologies.

    [Also: Top 5 ways to bring doctors to the EHR optimization table]

    "So there are lots of things to focus on as a CIO – notwithstanding all the security issues we've got to focus on too," he said.

    But even with so much going across Baystate – five hospitals, an academic medical center, 90 medical groups, a health plan with about 250,000 members, "a Next Gen ACO that we manage, and we're getting into a Medicaid ACO" – Vengco has generally felt pretty on top of things.

    [Also: Making the most of electronic health records is easier said than done]

    Except, until recently, with one important initiative.

    "The big project we've still yet to quite crack the nut on is: How do you optimize the EHR? How do you optimize the workflow for a clinician?" he said.

    Work for providers, on a day-to-day basis, just gets more burdensome, said Vengco. "They've got to document, they've got to bill – and then they have to see the patient at some point. And then that 15-minute visit becomes a 20- or 30-minute visit because you're doing all this other work."

    So Vengco posed a tall task to his IT team: Optimize the electronic health record and improve workflow for Baystate's clinicians. But do it, crucially, in a way where the clinicians take to the new approach voluntarily, because it works better for them, rather than having to be told to do so.

    "That was the challenge," he said. "To leverage our current legacy EHR, Cerner, but then really enhance it without ripping and replacing it."

    For help, he turned to Palo Alto, California-based Praxify, whose recently unveiled MIRA app can augment existing EHRs, integrating with legacy systems to improve workflow.
     
    Touted as being designed by and for physicians, the app offers capabilities such as "glanceable" interfaces that can surface key patient data for faster documentation and review, and dictation tools that enable voice-activated order entry.

    The app gives clinicians the "data and the functionality they need within one or two touches or clicks," said Vengco. "In our case, it's more of a mobile design, using the heuristics of swiping and all the mobile capabilities you're using in your day to day life.”

    To Praxify, he also had some clear instructions: "We can't spend two years doing this, we can't spend millions of dollars putting you guys on top of Cerner. That doesn't create value. What creates value is doing it in three to five months and actually getting adoption by the providers without me mandating use," said Vengco.

    "That challenge, happy to say, has been met," he said.

    Praxify connects with Cerner, using APIs, in just two or three months, he said. "Now we're going full force with a production deployment to our health system. And some of the preliminary feedback is that providers, who are some of the hardest customers, are saying they definitely want to use this,” he said.

    "We had a hospitalist, probably one of the most vocal critics of our EHR, initially said she wasn't going to use Praxify," said Vengco. "She said it was just another technology burden."

    Not long after trying it, she returned to the CIO with glowing reviews. "She said, 'This is amazing. It's incredible.'"

    Across Baystate, "we've seen efficiencies of, on average, 40 percent if you compare it to the way the EHR was previously being used," said Vengco. "They love the fact that they can get it on any mobile device. They love that, instead of taking five or seven or 10 clicks, it's a swipe, or a touch. It's efficient and fast. They love the design of it. They love that they can dictate.”

    Because it connects directly to the EHR, there's no concern about a loss of data. “And the design is intuitive enough that we don't have to do five or seven hours of training  – it's a 20-minute discussion and they're off and running," he said.

    The point, said Vengo, is that "I want them to adopt it themselves. If I give it to them and it goes viral, and they take to it, that means it's intuitive, it's optimized, and that makes me happy because the providers are happy."

     

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


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    PlushCare, a telehealth service provider, has launched an electronic healthcare record for the telehealth industry called Lemur. The company says it’s the first of its kind.

    The platform is designed to improve interactions between the physician and patient with a “physician-driven platform.” Officials said Lemur consolidates data and streamlines physician tasks to make it easier to access information during a telehealth visit.

    [Also: The doctor will see you now: Telehealth has a flasher problem]

    Lemur is cloud-based and HIPAA-compliant. It allows doctors to diagnose, treat, prescribe and provide ongoing treatment directly from the platform, according to officials. The platform reduces click-time for prescribing, note writing and ordering and reviewing labs.

    PlushCare collaborated with health information network SureScripts, API network provider Elligible and information analytics company Elsevier. Each of the company’s capabilities is fully integrated into Lemur.

    The platform connects patients to one of PlushCare’s 50 active physicians and operates in 16 states. The company plans to expand to other states in the near future.

    “Traditional EMRs available detract from the overall patient experience and greatly limit physicians’ ability to connect on a personal level with their patients,” James Wantuck MD, PlushCare’s CMO and co-founder, said in a statement.

    “Lemur bridges the gap by lifting the technological burden off of physicians more than any other EMR by placing all necessary patient information at their fingertips, creating the most human way to visit the doctor,” he said.

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


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    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-intro_0.png
    Slideshow Description: 

    Health systems have invested billions on electronic health records, and EHR vendors have kept pace in improving and enhancing their platforms. Yet, with all that, many in the healthcare field still hate them, especially physicians.

    So the question we placed to readers was simple: How can they be fixed?

    Healthcare IT News received nearly 100 answers from insiders at provider organizations, technology vendors and consulting shops and many of them came back to one word: usability.

    “Focus more on provider workflow and less on the tool,” wrote one health systems vice president. “Better user interface and workflow to reduce data entry clicks,” wrote a consultant who answered the survey.

    As part of our survey, we asked readers to pick their top EHR concerns and the results were mixed. About 21 percent said confusing user interface was the top EHR issue, 21 percent cited “too many clicks,” 20 percent pointed to interoperability issues and 18 percent picked workflow clashes with other clinical tasks.

    The following gallery highlights some of the more detailed responses we got.

    (Advance the slides to see each response)

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-7.png
    Slideshow Description: 

    "Develop bullet-proof NLP and a massively flexible workflow routing/decision support system. Bypass discrete form filling with hyper accurate NLP. Bypass rigid workflows with hyper flexible, adaptive NLP. Develop context-aware sessions so that relevant information is parsed and displayed at relevant context(s). Chain up workflows backend, and not do it front-end - cause Drs and Clinicians don't agree with admin/finance/regulatory/quality driven workflows."

    - Deputy CMIO, Hospital/Health System

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-1.png
    Slideshow Description: 

    "Reduce the amount of data that is required by government regulations. The natural course of maturity of EHR applications will take care of the rest."

    - Manager of EHR Applications, Hospital/Health System

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-2.png
    Slideshow Description: 

    "Incorporate AI and cognitive computing tools. The data is already in the system. Use it to anticipate the provider's next move."

    - CMIO, Hospital/Health System

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20slide-3.png
    Slideshow Description: 

    "Creating a more simple, easy to use user interface that follows the workflow of the individual role using it. Too many options can be too confusing."

    - Nursing Informaticist, Hospital/Health System

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-9.png
    Slideshow Description: 

    "Talk to clinical people that have had experience with multiple systems. There should be designers that have actually done the patient work and are part of a technical team that understands the blending of the two worlds. It is not easy, but is critical to a design that can provide clinicians with the tools to care for the patient. It is ALL about the patient. Simplicity is what is needed. Just because you can create a fancy system does not mean that is the way to go."

    - RN, Clinical IT Consultant

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-5.png
    Slideshow Description: 

    "Adapts to physicians workflow and has complete picture of patient no matter where or how to provide best clinical outcome."

    - President, Vendor

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/EHR%20Survey%20Slide-4.png
    Slideshow Description: 

    "Easy. End Cert for EHR. We need innovation. We do NOT need a US gov nanny state and policy market that has left us with a few very large, could care less vendors. We need new players. I'll say it again. We need innovation. Anyone with an ounce of EHR experience PRIOR to HITECH can tell you what needs to be done. Every time someone says MDs need to "document" that, they are removed from the team, fined and possibly fired. Every nonsensical data entry burden must be removed from EHRs. We want home health care, we know when we want it, don't ask us to document face time, why, etc. We are the doctors, listen to us. Stop getting in the way of our care. When I want an MRI of a knee on someone, there should be no question as I am a board certified, ortho surgeon, with 20 yrs experience. I know. So all preauth is now automatic for board certified MDs that want ANY test. Period. Stop all nonsensical note coding requirements. We do not want to read the same blah blah blah, normal prostate on female patients, etc. We want to know what the other MD is thinking and planning in 2 sentences. Decouple EHRs from billing. Encourage customization/workflow efficiency. Significantly improve usability by removing all US gov mandates. End ALL quality measuring, attesting, reporting, done by MDs. There is NO evidence it improves anything. Once we get a basic functioning EHR then look for interop. Not before. Stop listening to NON-front line, non-clinical MDs and ANYONE that does not have to work on a certEHR every day all day. Get real MDs on these committees. Stop penalizing MDs for anything related to EHR, measures, attesting, etc."

    - CMIO, Physician Practice

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    "Better workflow design for quickly accessing and recording patient information. Paper was more physician workflow friendly - replicate that and leave the data gathering to the computer system. Highlight fields which are regulatory/legal in nature. Have multiple submission/completion states - one for patient care and another for regulatory/legal compliance - they are not the same and a patient being treated expediently and with quality should outweigh the "cover-my-butt" mentality that the forms are being built with...so there needs to be a way for hospitals to separate the two - treatment documentation needs to be done during the critical times (time-sensitive) and legal follow-up can be done later in the office. Make them easy to do and separate...happy nurses and doctors."

    - Senior Programmer Analyst, Hospital/Health System

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    "Hello, I am not a practicing healthcare provider but work for a vendor for developing EHR's for my client. I am a doctor but left my practice 7 years back when I moved to Healthcare IT as an analyst. Based on my last 7 years of work experience in developing IT solutions for our clients, I feel that the biggest challenge has been of Interoperability between systems as we are aware that none of the hospitals/healthcare centers have a full fledged system from one vendor. I think that the one way in which EHR's can be improved is by increasing interoperability across various systems. I am not telling this because of the option mentioned below in the questions, but as my experience with clients this is a big factor that needs to be addressed. An open platform is the need of the hour that allows systems from various vendors to bring about the possible integration between these."

    - Senior Business Analyst, Vendor

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    "Stop letting the same CTOs / Product Managers / developers who continue to bring unusable, frustrating technology, mind numbing platforms to market to continue develop bad technology.

    Stop thinking that a single platform can solve all problems which results in massive platforms that can do lots of things but none well.

    Stop with the "interoperability" talk until you can convince the top vendors to truly be interoperable. Having EPIC sign the top 3 hospitals in our area and now they can "share data" is not what the heart and soul / goal of "interoperability" is about.

    Remember that ultimately, while it is ALWAYS about the patient, the very nature of healthcare is the PERSON WHO DELIVERS CARE to the patient. Every vendor, CTO, product manager, developer should have to use, in a real-life setting, the crap they develop to develop empathy for the end-user and other stakeholders.

    Great tech cannot be developed in a vacuum. To truly transform the platforms that document and monitor the care delivered, to disrupt this market, vendors, providers, hospital systems have to look beyond the top 5 badly functional but unusable "but we will make due with it" platforms. There are a lot of great user and patient centric design people in lots of different industries and we desperately need those in health IT.

    Give those trying to disrupt and make a positive impact on both the end-user and the patient a fighting chance. The big vendors should be working with smaller startup ventures with both support, mentoring, challenging the status quo, and working towards creating usable tech to improve patient outcomes.

    Design is not a nice to have. Great design is critical to great software, great user experience, and great EHRs."

    - CEO, Vendor

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    "Too much data is spread across too many screens. It's not a click count issue, it's a problem with data not being presented in a meaningful manner to users whether clinical or administrative. Patient demographics and vitals should always be visible to clinical staff and telemetry should be integrated (interoperability with IoMT) for all, not just anesthesiologists and ICU staff.

    Physicians should have the patient's information and their documentation available in an at-hand manner to be edited in a format that matches their form and prose.

    Administrative staff like coders should always have demographics and diagnoses visible. Billers should always have demographics, insurance and monetization factors visible.

    CQM staff should always see census and trend information important to their facilities. Whether in a clinical setting or administrative the patients should always be the focus and the presentation of the patient's reason for visit pertinent to the role in question should immediately follow.

    We need to move the focus away from role based security as a methodology only for securing a system and make it control the functionality available to users. Users who receive access denial messages shouldn't see them with the frequency they do. If an area of the software isn't intended to be used by someone in a specific role that data, that sub-application, shouldn't be available for access. This has the added benefit of respecting PHI by segregating and limiting information visible to various parties. Role management, role based security, needs to move beyond thinking of security as approving or denying access to information and start respecting information management as part of it's general function."

    - Junior Systems Admin, Hospital/Health System

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    "Minimize or eliminate need for 3rd party and create one system that works throughout."

    - Clinical Informatics Architect, Hospital/Health System

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    "EHRs increase the burden on physicians. They don't make our jobs easier. They were built for billing, not clinical tasks. They don't accommodate our needs with patients at the point of care."

    - Physician, Hospital/Health System

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    "Reducing clicks and organizing user interfaces is elementary. The true crux of the issue is optimizing the EHR workflow to support and enhance clinical tasks and medical decision making as opposed to clashing and hindering it."

    - Senior Director, Vendor

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    "Focus on shared data elements, to avoid duplicating data entry. Automate as much as safely possible. Establish processes to involve user feedback and implement efficiently."

    - Applications Coordinator II, Hospital/Health System

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    "User training could be smoother. Software needs to be made in mind that not every user is tech savvy."

    - Systems Analyst, Consultant

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    "It can be greatly improved by making Healthcare Record Standards, like the one we have for Real Estate (www.reso.org). Then we should have all EHR Software adhere to this new standard."

    - Owner, Physician Practice

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    "Clinicians should be driving the design of EHRs, not technology professionals. CIOs in healthcare facilities should have clinical backgrounds."

    - Nurse, Vendor

    Teaser: 

    Healthcare IT News received nearly 100 answers from insiders at provider organizations, technology vendors and consulting shops. Here are some of the best.

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    EHR problems
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    Healthcare IT News received nearly 100 answers from insiders at provider organizations, technology vendors and consulting shops. Here are some of the best.
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    Leidos
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    As the industry shifts to value-based care, healthcare organizations are realizing the need to optimize their EHRs in order to gain clinical and financial return on investment.


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    Recent improvement in hospital surveillance technology for sepsis detection is leading to longer lives, according to a new report from KLAS that examined monitoring tools from blue-chip EHR vendors and smaller standalone products.

    About 69 percent of the 95 providers polled say the IT systems have led to improved patient safety outcomes, according to KLAS, with some reporting a 50 percent drop in mortality. Other benefits included lower treatment costs, shorter lengths of stay and fewer readmissions. Still, 23 percent said it was too early in their rollout of the surveillance and treatment systems to have reliably reportable results.

    Perhaps unsurprisingly, Epic and Cerner together represent the largest customer base for sepsis technology – with more clients than than all other vendors combined.

    [Also: Clinical Sensors lands $1.5 million in NIH grants for sepsis work]

    Customers of both EHR giants say their surveillance tools have led to improved patient outcomes, including mortality reductions. But KLAS noted that the two vendors have quite different strategies for helping hospitals detect septic and pre-septic patients.

    Cerner's "always-on algorithm and related alerting are easily deployed and available for free" to its customers, according to the report, while an advanced analytics and dashboard module are available for a fee.

    Epic's Best Practice Alerts, meanwhile, are made available free to customers. But KLAS reports that those providers that are live or in-process with Epic's sepsis functionality say "implementing and integrating it into current workflows requires significant in-house effort."

    Other big-name EHR vendors have limited market share: MEDITECH recently developed a sepsis tool for its 6.x platform, but KLAS says awareness about it is low. Allscripts doesn't have sepsis-specific technology, but will help its clients customize their systems with other tools.

    Among the offerings that could help do that are specialty infection control and surveillance modules from vendors such as Wolters Kluwer and VigiLanz. The report quotes one CMIO's high marks for the former, whose POC Advisor tool "pulls data out of our EHR to an engine with all of these rules and then shoots alerts to mobile devices," he said. "We are giving needed information to providers at the point of care no matter where they are," he said. "We get more of a real-time perspective versus the retrospective chart reviews that we would get three to six months later."

    Other less common approaches include deploying analytics from vendors such as Health Catalyst and LogicStream. Beyond real-time alerting, those companies "leverage their analytics to provide retrospective views of clinical effectiveness and spur effective end-user change management," according to KLAS. "Customers appreciate Health Catalyst's strong partnership and focus on customer success, while LogicStream clients extoll the flexibility and usefulness of their reports."

    Still, the report shows that, all things being equal, hospitals would prefer to use their EHR vendor when possible, noting that Epic and Cerner are both seen as relatively more competitive on infection control than their competitors. Meanwhile, "most traditional market mainstays in infection control and surveillance have not leveraged their market presence or technology to help more than a few customers combat sepsis, and few providers look to other third-party vendors."

    In addition to providers with surveillance tools in place, KLAS also polled more than 100 providers who had yet to install sepsis-detection technology: 53 percent are considering either a new EHR module or in-house developed add-on using their existing platform; 19 percent are considering third-party tech and 28 percent aren't yet in the market.

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


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    The U.S. Coast Guard published an EHR acquisition request for information to FebBizzOpps.gov, a move effectively striking the final nail into the coffin of a failed Epic implementation.

    “This Request for Information (RFI) is part of a market research effort to assess industry capabilities that will best address the U.S. Coast Guard’s (USCG’s) need,” FedBizOpps noted.

    The RFI comes almost a year to the day after the Coast Guard terminated its EHR contract with Epic — and actually reverted to using paper records — because of significant risks and various irregularities it uncovered.

    [Also: U.S. Coast Guard pulls out of Epic EHR contract, forcing return to paper records]

    The Coast Guard is now seeking information about both on-premise and cloud-based EHRs, including the option to share a hosted electronic health record service with another federal agency as it tried to do with the U.S. State Department for the Epic installation.

    Coast Guard’s RFI documents also include a list of use case scenarios and a capabilities checklist that suggest a strong focus on data interoperability, population health, surveillance features, mental health, patient safety, as well privacy and security functions, among others.

    [Also: Paper or pixels? Clunky EHRs have providers looking to the past]

    “The solution will protect Personally Identifiable Information (PII) and Personal Health Information (PHI) and will markedly enhance core and priority USCG health care services and improve interoperability with both the Department of Defense (DoD) Military Health System and the Department of Veterans Affairs (VA) health systems,” Coast Guard officials wrote.

    Final responses to the RFI are due May 26, 2017. 

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com


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    Healthcare executives have a sunny outlook for telehealth investing, according to a recent American Telemedicine Association survey touted at its 2017 conference and tradeshow in Orlando this week.

    ATA's National Executive Leadership Survey polled more than 170 healthcare executives nationwide and found that a commanding majority – 88 percent – plan to invest in telehealth technology this year. Just 1 percent of execs said they weren't at all likely to invest in telehealth.

    The reasons for those IT investments are almost as interesting as the newly robust embrace of a strategy whose slow adoption has long frustrated telehealth advocates. According to ATA, executive respondents see telehealth not just as a way to increase access for underserved patients, but as a competitive advantage.

    [Also: NewYork-Presbyterian builds out telemedicine psychiatry and express care services]

    A whopping 98 percent of healthcare execs said offering telehealth services could serve as a market differentiator over other organizations that don't have distance-based care capabilities.

    Still, barriers that have long stymied more widespread deployment of telehealth remain. Respondents said key challenges over the next three years will continue to include: reimbursement issues (71 percent); licensure and privileges (53 percent); resistance to change (50 percent); lack of evidence of financial ROI or quality gains (36 percent); provider recruitment (22 percent); legal liability (20 percent); bandwidth limitations (19 percent), and privacy and security (15 percent).

    The good news is that nearly half of the execs polled say increasing consumer demand will be enough to overcome many of those hurdles, and fuel growth in virtual care in the next few years: 48 percent said consumerism will be the biggest telehealth trend between now and 2020. More than one-quarter (26 percent) said the shift to value-based care will offer further incentive for telehealth adoption.

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


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    Epic will embed authoritative health information from Mayo Clinic in its MyChart and MyChart Bedside portals, aiming to give patients the opportunity to put their healthcare into context

    Mayo Clinic medical experts routinely review and update the evidence-based content – articles, videos, slideshows, Q&As and more – with new material, provided in English and Spanish, which is added weekly.

    Epic hopes that offering patients at its ambulatory and inpatient clients access to this expertise – more than 18,000 pages of it, covering some 4,000 healthcare topics – will help them learn more about symptoms, conditions, healthy living information and more.

    [Also: Epic says App Orchard now open for business]

    "Making Mayo Clinic's world-class health knowledge available within MyChart and MyChart Bedside can help patients understand and better manage their health and well-being," Epic President Carl Dvorak said in a statement.

    Patients using the online MyChart portal and MyChart Bedside inpatient tablet apps can access the material by tapping a keyword in their chart, or clicking the HL7 Infobutton within those applications.

    Mayo-derived information will then be displayed according to the chart elements such as test results and diagnoses. The information will give patients more background and context for problem lists, health maintenance, medications, allergies and results review.

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


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    What began as a straightforward software contract with Epic resulted this week in the U.S. Coast Guard starting its entire EHR acquisition process over some seven years after it began.

    EHR implementations are notorious budget-busters often fraught with missed deadlines and other unforeseen complications, but for an organization to abandon the project altogether and embark on a new beginning is uncommon.

    Indeed, this occurrence includes some finger-pointing from both sides. So what exactly went wrong?

    October 5, 2010
    The Coast Guard awarded Epic a 5-year $14 million contract for what it said at the time would be a state of the art electronic health record platform with modules for dental, laboratory, patient portal, pharmacy, and radiology.  Epic was also contracted to offer training, testing, backup services and help desk support.

    April 22, 2016
    Citing significant risks and various uncovered irregularities, the Coast Guard pulled out of its contract with Epic.

    "The decision was driven by concerns about the project's ability to deliver a viable product in a reasonable period of time and at a reasonable cost,” Lieutenant Commander Dave French, the Coast Guard's chief of media relations said then. “As a result of the analysis that led to the discontinuation of the project, various irregularities were uncovered, which are currently being reviewed."

    At that point, the Coast Guard returned to using paper-based records for patient care.

    French also said the Coast Guard would restart its EHR search.

    April 26, 2016
    After the Coast Guard said it was closing its Epic contracts and setting invoices, the EHR maker posted to its website a reaction piece titled Epic and the U.S. Coast Guard: the Facts where the company said the storage area network housing the software project was “inexplicably corrupted with no root cause,” and twice deleted by employees of Leidos, the Coast Guard’s partner tech support partner for the project, immediately prior to go-live. Epic also said there were hardware procurement delays, a change to the datacenter, re-contracting issues and a federal investigation, all of which pushed back the project timelines.

    “We did everything in our power to complete the install. We fulfilled the terms of the agreement and provided the software and implementation services to meet the Epic obligations of the project,” Epic said. “The software was ready to go live.”

    April 23, 2017
    The Coast Guard’s new beginning emerged in the form of requests for information the Coast Guard posted to FedBizOpps.gov to understand what products are on the market today including cloud-based and on-premise options.

    It’s early in the process. RFIs, in fact, are really meant as an information gathering step so the agency can get a sense of what a state of the art EHR looks like today, which capabilities vendors can either address now or build into their products in short-order and identify features the Coast Guard might like but are not yet realistic.

    A look into the RFIs found that the agency is seeking information on EHR functions concerning information interoperability, population health, surveillance features, mental health, patient safety, as well privacy and security functions, among others.

    And, of course, it needs to be interoperable with the U.S. Departments of Veterans Affairs and Defense — which already has some industry insiders speculating that the Coast Guard could pick Cerner for its next EHR.

    Twitter: SullyHIT
    Email the writer: tom.sullivan@himssmedia.com


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