U.S  Department of Health and Human Services Secretary Tom Price on Thursday said what many doctors are thinking: “We need our physicians to be patient-facing, not computer-facing.”

But that doesn’t mean he’s opposed to robust health information technology.

Price, speaking at the Health Datapalooza Conference, said he supports efforts to achieve true interoperability between electronic health records and other systems, but not at the expense of physician face-time with patients.

“The promise of health IT is so great, but we must recognize that a one-size-fits-all, inflexible system for our nation’s patients and physicians simply will not work,” he said, according to Politico.

Price, a surgeon himself, stopped short of promising rigid government oversight over efforts to improve healthcare technology. Like many positions tied to the Trump administration, Price advocated for private-sector leadership and said HHS will “encourage interoperability from the 60,000-foot level.”

Price also hinted at removing some of the reporting burden tied to the meaningful use program, which likely appeased those who have been pushing for a softer policy in dictating health IT adoption.

Twitter: @HenryPowderly
Contact the author: henry.powderly@himssmedia.com

Roger Severino on Thursday described himself as the top cop of health IT. And with the sector facing rising security threats, he’s taking it seriously.

“I came into this job with an enforcement mindset,” the new director of Department of Health and Human Services Office for Civil Rights said during his brief morning session on Thursday and Health Datapalooza in Washington, D.C. “Congress established OCR to adapt to new technology -- and to protect it.”

[Also: Health IT important, but too burdensome for doctors, Tom Price says]

At the forefront of Severino’s mind was reiterating the need for a culture of trust to support the safe exchange of health data. He encouraged the audience to be vocal about their concerns and to make suggestions about where the agency can improve.

“We’re here because we’re about making health better,” said Severino. “We want to make health IT work for physicians, promote interoperability and safeguard data from falling into the wrong hands.”

When Congress passed the HITECH Act in 2009, it was designed to unleash the power of the electronic health record, empower consumers and jumpstart the big data revolution, he said. But in passing the law, it also significantly increased the penalties for HIPAA violations.

“Security with data is essential, and is a foundation for data sharing,” said Severino. “Health data, user interoperability and privacy and security all run together.”

[Also: Senate Dems blast Severino as bigoted, unqualified to lead OCR]

Severino highlighted the most recent OCR settlement with CardioNet for $2.5 million as an example of how important it is for organizations to safeguard patient data and take reasonable steps to ensure confidentiality.

Ransomware was also top of mind, as the “data may be compromised, destroyed, gone forever -- and it’s very likely the organization will have to report it to OCR.”

“There’s also the bigger picture behind this: the people affected,” Severino said.

OCR is taking to steps to ensure organizations recognize the differences between covered entities and those that are not, what information can be disclosed, and provide assistance on how “new and emerging technologies and apps can actually work within the rules to share information and provide information to consumers, while protecting patients and privacy,” he said.

“We’re here to enlist and adapt to emerging situations.”

Twitter: @JessieFDavis
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Partners Connected Health, a division of Partners HealthCare, is broadening the reach of its Online Second Opinions Service to include the collection of medical records and radiology and pathology test results.

A new agreement with West Corp.'s Health Advocate subsidiary will expand the offerings of the second-opinion service, which gives patients and physicians online remote access to specialists at worldwide hospitals affiliated with Partners.

A recent review of online second-opinion consults at Partners members – Brigham and Women's Hospital, Massachusetts General Hospital, Dana Farber Cancer Institute and Spaulding Rehabilitation Hospital – found that in 90 percent of the medical cases reviewed, Partners specialists recommended a complete change in the treatment plan.

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

What's more, in 5 percent of cases, the specialist consulted online recommended an entirely new diagnosis.

Health Advocate aims to help patients individuals navigate the complexities of the U.S healthcare system. Its clinical teams of personal health advocates – including registered nurses, medical directors –  offer confidential support to patients seeking second opinions through the Partners service, helping collect and submit medical records for physician review.

Online second-opinion services are growing in importance and maturity as connectivity among hospitals and health systems evolves. This month, for example, NewYork-Presbyterian expanded its own telehealth suite, which includes a similar service enabling NYP patients to consult with from other affiliated physicians across 80 specialties. Their doctors, meanwhile, can use the tool to enable virtual visits post-surgery and other care follow-ups.

Twitter: @MikeMiliardHITN
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OpenNotes was awarded the Health Data Liberator Award at Academy Health’s Health Datapalooza in Washington, D.C. on Thursday afternoon.

Started in 2013, the Health Data Liberator Award recognizes organizations that make data available for use and accelerate data sharing in the healthcare industry.

“While we should absolutely celebrate the team effort on data liberation, that’s not the same as getting everyone on the same page,” DocGrapher CEO Fred Trotter said in announcing OpenNotes as the winner. “To do that you have to do something else.”

[Also: OpenNotes hits 10 million patient milestone]

“This recognition means a lot to us,” said OpenNotes Co-Founder Jan Walker. “It’s a real hope that this will nudge more providers to adopt this approach to openness… We are indebted to countless providers who have expanded on our original idea of opening notes to patients.”

OpenNotes Co-Founder Tom Delbanco, MD was a bit more direct in his acceptance speech: “She wants to give you a nudge, I want to give you a kick. … Every medicine developed is designed for the greater good of the people, which is the core foundation of OpenNotes, said Delbanco. “It’s freedom of choice.”

The organization has faced pushback, as adoption requires a huge culture change. Delbanco said that doctors are used to being in control of their notes and have provided plenty of excuses for why they don’t want to participate in open note sharing -- including calling OpenNotes another technology platform.

“But it’s not technology: It’s give me the damn note,” said Delbanco. “I don’t want you to just nod your head in agreement. I want you to leave here to do something about it. We believe this is the standard of care. We think clinicians will be saved by patients. We think they need to get together with a transparent exchange of information.”

Twitter: @JessieFDavis
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While the resounding opinion is that the Department of Veterans Affairs should replace the proprietary VistA with a commercial EHR, perhaps choosing Cerner as the Defense Department did, that idea does not hold so true within the open source community.

“When you look at the big trends in the IT industry, open source is used everywhere. In fact, some of the most successful mega IT systems have a significant open source component,” said Seong Mun, CEO of the Open Source EHR Record Alliance. “We believe it’s the right methodology to get to where we need to go.”

VA Secretary David Shulkin, MD, is expected to decide in July.

Open source is designed as a community-based source software development and education. The source code is available to the general public for use or modification from the original design, Mun said. It’s not just using another vendor’s code, but a true collaboration such that organizations take code, improve upon it and release those enhancements back into the community. 

[Also: Of course VA should replace VistA with Cerner, readers say]

The VA established OSEHRA for that very reason, Mun said, and much of VistA’s software has been in the public domain for years: Vista-based products are available around the world.

Indeed, that means OSEHRA’s fate is at least tangentially related to VistA — as is that of Medsphere, which provides an open source EHR that leverages VistA called OpenVista. 

Medsphere CEO Irv Lichtenwald, in fact, said Medsphere could potentially take the VistA code and evolve it at a fraction of the cost VA would spend on a commercial EHR. 

“The answer probably lies in the VA turning over VistA code maintenance to an outside party with sufficient expertise,” Lichtenwald said. “That external technology partner will take the base code and continue to evolve it under VA specifications.”

[Also: Expert to VA: Pick any vendor but Cerner to ignite EHR interoperability]

That is exactly what the VA would be doing with a commercial option, and essentially how large-scale software development projects work. 

“Basically, this approach turns VistA into a commercial option itself,” Lichtenwald said. 

While EHR code source software is important, it’s really about customizing the package to meet an organization’s needs, Mun said, adding that the VA is soliciting merely views from the wider community with its recent RFIs to understand its options and assess available products but that doesn’t mean it has abandoned the possibility of modernizing VistA altogether at this point. 

[Also: VA weighing multiple platforms, cloud-based options for VistA replacement]

“VistA is a viable option,” Mun said. “Often times we get focused on product X-Y-Z. But if you look at reports, it’s more about how to manage the software product over the long term. No matter who you buy in the industry, it’s not a solution. You have to evolve whatever you buy.”

While Mun and Lichtenwald favor the open source model it’s up to Shulkin and the VA to wrestle with the choice between open source and a commercial EHR.

“Open source,” Mun said, “can be the way to modify for the enterprise.”

Twitter: @JessieFDavis
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Cerner still has the greatest market share for electronic health record vendors in the United States, beating out top rivals Epic and Mckesson, according to the latest Kalorama report.

McKesson’s market share was second while Epic came in third. The positions were the same last year.

The report, EMR Market 2017: Electronic Medical Records in an Era of Disruption, also showed that several smaller companies are flourishing.

[Also: With EHR-based sepsis detection, Epic and Cerner have different approaches]

Kalorama sees plenty of opportunity for disruption, though, as frustrated physicians and hospitals are itching to switch vendors and the Trump administration’s changes in government policy shake up outlooks.

"A few companies have more than half the market, but it's still true to say no company – not even the largest healthcare IT firms – have even a fifth of this market," Bruce Carlson, publisher of Kalorama Information, said in a statement.

Spurring disruption, according to Kalorama, are EMR users unhappy with usability, vendor-switching, lack of mindshare in the market and customers who simply want something better. 

Cerner is continuing to add new business and services with CernerITWorks, a suite of services that tackles a variety of tasks for hospital IT departments.

[Also: How the Coast Guard’s ugly, Epic EHR break-up played out]

Kalorama also said Cerner’s RevWorks, which offers RCM services, is helping the company stay very strong in the hospital IT market. Also, Cerner’s past acquisition of Siemens IT was a major move that boosted Cerner's market share and the company’s securing of the Department of Defense EMR contract also aided its position in the market.

As for McKesson, Kalorama sees it as positioned to expand its offerings. It already offers a full range of solutions ranging from medication safety and revenue cycle management to resource utilization.

Third-place Epic, however, boasts that several of the large and prestigious healthcare systems across the country are customers, and Kalorama expects the Verona, Wisconsin-based company will continue to land a significant share of the new business in the EHR market.

Allscripts Healthcare Solutions is fourth according to Kalorama. The company has been in top five for several years.

GE Healthcare, athenahealth, Intersystems, QSI/NextGen, Meditech, Greenway, eClinicalWorks and at least 600 other companies make up the rest of the market.

Twitter: @Bernie_HITN
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In 2014, Wake Forest Baptist Medical Center in Winston-Salem was losing tens of millions of dollars and a major cause was the costly roll-out of both an Epic EHR and Oracle’s PeopleSoft human resource management system. 

The situation was so dire that Wake Forest posted losses of $78.4 million that year. And that was after Wake Forest saw operating losses total $53.6 million in 2013 and Standard & Poor’s later downgraded its credit rating as a result.

“When I came to Wake Forest in 2014, I was tasked with leading the institution’s turnaround,” said the system’s CFO Chad Eckes, who originally signed on as CIO. “Much of the problems back then were rooted in IT struggles.”

Broken here, compromised there

The Epic and PeopleSoft implementations, taken together, were a veritable money pit for Wake Forest. 

“Those software projects literally broke the organization financially,” Eckes said. “We were losing money at the time as a result of some of the broken pieces and systems in place.”

One major problem was the core infrastructure, in which Wake Forest had underinvested as a way to afford the pricey PeopleSoft and Epic software projects. 

[Also: Coast Guard seeks new EHR vendor after failed Epic implementation]

Sixty-four percent of its data center equipment was more than seven years old and frequently broke down. Wake Forest lacked modern standardized equipment because it had previously treated IT procurements episodically, that is to say on a single project-by-project basis. As such, the IT shop would purchase hardware, implement it for a particular initiative, and then not have enough budget to upgrade when the time came. 

“As a result, our system was highly compromised,” Eckes said. Enough so, in fact, that even the board was concerned that if IT were to shut the system down, they couldn’t be certain it would even come back online. 

The solution: Convergence

Issuing what Eckes described as an immediate call to action, the board authorized a significant investment to allow Wake Forest to find a more robust platform that ultimately would lead to a strong return on investment from a tangible basis.

Eckes and his team determined the antiquated platform needed to be replaced, as it was underperforming in terms of speed. With 4,000 to 8,000 users on the Epic system, it could take multiple seconds just to load between each click because the infrastructure wasn’t correctly sized.

Wake Forest chose a converged infrastructure with a hybrid cloud, Dell EMC Vblock, because it was exponentially faster than other options and wouldn’t require more staff, Eckes said. 

[Also: Epic, Allscripts only big-name EHRs certified for 2015 edition; See the list]

The majority of the project time was spent waiting for the Vblock to be installed in the factory, which took about three months Eckes said. Once that finished, the equipment was installed in less than two days and ready to begin transferring to the system.

Wake Forest chose for self-service to be built into the application, which allows the IT team to create its own storage provision. 

The platform is not only fully standardized, but it moved from 2 percent virtualization to 95 to 100 percent. The organization also moved 16 physical servers to the new platform.

The plan worked

Wake Forest dramatically improved data center and software uptime from the low-80 percent range to nearly 100 percent, Eckes said. 

“Every transaction has improved by 30 to 40 percent,” Eckes explained. “If you think about nurses and clinicians, they’re doing these transactions hundreds of thousands of times a day.  We gave them back 30 minutes to an hour of work time that can be used to see patients.”

Eckes also highlighted an increase in speed and value Wake Forest achieved by moving from its prior episodic procurement model to constantly maintaining systems, which nearly eliminated the setup time for projects

IT staff maintenance was down 70 percent. In the past, IT could spend 30 percent of project time on setup, now it’s down to hours or, at most, a few days.

[Also: Allscripts, Cerner, Epic signal more open EHRs ahead]

Wake Forest also eliminated the need to build out a new data center space: Rather, it replaced 45 racks of IT per data center down to 15 racks of converged infrastructure per center.

“For the most part, transitioning to the converged infrastructure wasn’t an event staff knew about,” Eckes added. “We made sure it wouldn’t impact staff. It made the clinician more excited as they knew it would increase up-time and performance.”

The bonus: Wake Forest’s most recent financial statement shows revenues of $1.3 billion, which is 12.7 percent higher than the prior year.

Twitter: @JessieFDavis
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Georgia-based health IT provider Greenway Health has been hit with a ransomware attack that affected a limited number of its customers, the vendor announced this week.

The cyberattack has limited some internet-hosted users of Greenway’s Intergy platform, which is a certified complete electronic health record with practice management, practice analytics and patient portal.

[Also: Greenway Health to unveil care coordination services]

Fortunately, the company has backup data and expects little to no data loss. Greenway Health CEO Scott Zimmerman said there is currently no evidence that any patient data has been exfiltrated or misused.

Greenway will provide customer support and service to the affected practices. Officials said customers who haven’t experienced difficulty will unlikely be affected by the ransomware attack.

“Based on our current understanding of the circumstances, we have no reason to believe this attack will extend to our customers on other platforms,” said Zimmerman. “Though we build extensive safeguards into our products and services, no Internet-based system is completely immune from attack.”

“We’re continuously focused on evaluating additional measures that we may take to further enhance our defenses against cybercrime,” he said. “We deeply regret any disruption this criminal attack could cause to your practice and for any concerns it may cause to your patients.”

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Cerner president Zane Burke said that the EHR vendor’s work with the U.S. Defense Department first go-live was successful and it’s on track for three subsequent pilots planned for this year.

“This project is making Cerner better, and I believe it ultimately benefits all our clients and is leading to enhanced implementation processes, advancements in cyber security, and sometimes connected technologies,” Burke said during an earnings call Thursday. “We remained very focused on continuing to deliver for the Department of Defense, which we believe will help prepare and position us for other opportunities.”

[Also: Allscripts, Cerner, Epic signal more open EHRs ahead]

CFO Marc Naughton explained that revenue for the first quarter of 2017 was $1.26 billion, up 11 percent over 2016, fueled by systems sales and services. Cerner’s first-quarter profit was $173.2 million, a 15 percent jump over the same period last year.

Burke pointed to population health and revenue cycle technologies specifically and attributed the growth to “multiple head-to-head wins against our primary competitor.”

Research firm Kalorama published a report on Thursday, EMR Market 2017: Electronic Medical Records in an Era of Disruption, that ranked Cerner as the market share leader followed by McKesson and Epic.

And when asked about the request for information that the Department of Veterans Affairs posted last week, Burke said that VA did so to get a better understanding of exactly what’s available in the commercial market.

“They have contracted with certain third parties to help do that review, and really make a determination as to whether they look at a commercially available off-the-shelf system, or COTS system, or stay with their Vista solution today. They could go back into – so, anything beyond that is speculation.”

 [Also: Open source experts to VA: Keep VistA, it can be fixed]

Twitter: SullyHIT
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Only 30 percent of 1,859 measured hospitals fully meet the Leapfrog Group patient safety standard for use of bar code medication administration technology, but a significant 74 percent fully meet the group’s patient safety standard for use of computerized physician order entry systems to minimize medication errors, according to a new study from the Leapfrog Group.

On the barcode side, another 35 percent made substantial progress toward the standard by fulfilling three of the four requirements, and an additional 26 percent made some progress, meeting two of the standard’s four criteria. Nine percent met one or none of the criteria.

[Also: These 10 hospitals scored an 'F', pose greatest risk to patients, Leapfrog says]

The four criteria of the Leapfrog BCMA standard include:

• Implement a BCMA system linked to an electronic medication administration record (eMAR) in 100 percent of the hospital’s medical and/or surgical units and intensive care units.
• Scan both patient and medication barcodes in 95 percent of bedside medication administrations in BCMA-equipped units.
• Hospital’s BCMA system includes all seven decision support elements identified as best practices by the Leapfrog BCMA Expert Panel, including wrong patient, wrong medication, wrong dose, wrong time, vital sign check, patient-specific allergy check and second nurse check.
• Hospital has implemented all five best practice processes and structures to prevent workarounds, including a formal committee to review BCMA use, back-up systems for BCMA hardware failures, a help desk to respond to BCMA issues, observation of users using the BCMA system, and engaging nursing leadership.

On the CPOE side, the percentage of hospitals fully meeting Leapfrog’s standard for CPOE systems has risen steadily over the past five years. In 2016, 74 percent of hospitals fully met Leapfrog’s CPOE standard. This represents an increase of 10 percent over the prior year and more than double the percentage of hospitals meeting the standard in 2012.

[Also: Medical mistakes still kill 1,000 patients a day, Leapfrog says]

The two criteria of the Leapfrog CPOE standard include:

• Order at least 75 percent of inpatient medication orders through a CPOE system that includes decision support software and is linked to key hospital information systems to reduce prescribing errors.
• For adult and general hospitals (standard excludes pediatric facilities), demonstrate that the system alerts physicians to at least 50 percent of common, serious prescribing errors by participating in Leapfrog’s CPOE Evaluation Tool.

When nurses use a BCMA system as directed, the error rate in administering medications is reduced by up to 93 percent, according to a VA study cited by Leapfrog.

[Also: Leapfrog medical errors calculator gives hospitals real cost of deadly mistakes]

CPOE systems have been highly effective at reducing the rate of serious medication errors, decreasing error rates by 55 percent -- from 10.7 to 4.9 per 1,000 patient days, according to the Journal of the American Medical Association. Rates of serious medication errors declined by 88% in a follow-up study by the same group, according to a Qual Safe Health Care study.

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A new survey from MGMA has found that medical practices have mixed approaches to analyzing their electronic health record data.

The survey found 31 percent said they use their EHR analytics capabilities to the fullest extent; another 31 percent said they deploy a combination of EHR analytics along with help from an external vendor partner; 22 percent said they use some of their EHR's analytic capabilities; and 5 percent said they rely on an external vendor.

But a not-insubstantial 11 percent of survey-takers said they don’t perform analytics at all on their EHR data, according to the poll.

[Also: EHRs are everywhere: Now what?]

MGMA Principal Derek Kosiorek said he understands the wide disparity in providers' analytic maturity. After all, most EHRs weren't built for data analytics, but as electronic information repositories.

In the post-meaningful use EHR rush, many systems, in order to be more palatable to paper-reliant physicians, were designed to emulate paper records, he said in a blog post, rather than to interpret, aggregate or organize the records.

“For many practices, reports produced by the EHR were either pre-installed with the product or configured by the vendor during implementation," said Kosiorek. "To these groups, the ability to generate new analytics walks out the door with the product implementation team."

Even savvy medical staffs are forced to rely on assistance or add-ons from outside vendors to help them with analytics.

But even though many physician practices don't have the resources to do so, the imperatives of value-based care make the ability to leverage clinical, administrative and financial data vital, he said.

The good news is that EHRs and analytics tools are "improving in exciting ways and will soon live up to the promise that brought us into the electronic age," said Kosiorek. "I often say that clinical providers do not dislike EHRs as a concept – they dislike the EHRs they have been given. Today, it is more difficult to get the job done with the tool than it is without it. But data analytics have the power to change all that."

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While the industry is waiting for the Department of Veterans of Affairs to pick Cerner an off-the-shelf EHR to replace its legacy VistA electronic health record, a VA official on Friday said fixing the maligned platform isn’t being ruled out yet.
 
The EHR selection is one of the biggest projects the agency is working on right now, and VA realizes it needs to modernize, said VA’s Acting Undersecretary for Health Poonam Alaigh, MD, at the Health Datapalooza event. “We’re looking into modernizing VistA or using a commercial-off-the-shelf EMR.”

[Also: Of course VA should replace VistA with Cerner, readers say]

“It’s crucial to modernize the system,” she said. “VA is engrained into the healthcare society. When the VA makes progress, the rest of our healthcare system makes progress.”

Technology and modernization is at the heart of the VA’s goals, evidenced by the recent launch of the Access to Care site that provides veterans transparency on wait times and clinical care quality.

VistA has been a hot topic of debate, since VA Secretary David Shulkin announced the agency would make a decision on its future by July. From keeping VistA and shifting to open source, to canning VistA and moving to Cerner, there are many viable options for the outdated system.

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

In the healthcare industry, however, many expect Cerner will get the contract, especially in the wake of its deal to modernize the Department of Defense’s system.

Black Book, which rates tech platforms, recently said Cerner would be the right choice for the agency, as well.

However, there have been outliers. Open source advocates, for example, think the VA should just improve VistA using open source code. At the same time, a Chilmark Research executive said picking any vendor other than Cerner would be a better choice if the agency wants to advance interoperability.

The VA is expected to make its decision on whether to seek an off-the-shelf product in July.

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Fusionetics, a health performance platform for athletes, will collaborate with Cerner to integrate Fusionetics’ assessment programming with Cerner’s HealtheAthlete, the companies announced Monday.

The web-based HealtheAthlete platform provides in-depth management of athletes’ health and treatment for sports medicine staff, officials said. The platform also manages and shares athlete health-related data with training staff.

[Also: Cerner adds concussion care platform to athlete management system]

Fusionetics’ tools help athletes better understand, monitor and improve performance. Officials said the collaboration will provide athletes and sports organizations access to the company’s benchmarking and analytics, while providing customized training programs and treatments through HealtheAthlete.

The goal of our collaboration is to support people to move better, perform greater and recover faster by using modern technology,” Fusionetics COO Ben Tucker said in a statement. 

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Athenahealth CEO Jonathan Bush said the company is in the early stages of creating a patient market share guarantee, a national calendar asset and a master patient index.

Citing an unusual finding that both the number of patient visits and payments per visit are down a couple percent, Bush said during an earnings call with analysts that athenahealth has a small internal team working on the guarantee. Bush also offered a glimpse into some of the research and development projects and technological adjustments the vendor is making for what he called the post-Obama world.

[Also: Wake Forest's Epic EHR rollout was a money pit. Here's how they turned it around]

“Most people think of same-store growth in healthcare as driving up utilization of testing for patients and driving up the payment per procedure or test. We are not going to plan on that being part of the growth scenario for the next several years and, instead, we're focusing on stealing patients from other providers in the name of our providers,” Bush said.

That is one of the adjustments athenahealth is making for the healthcare industry under the Trump administration. The other is to increase the number of menial tasks, such as authorizations, handling lab follow-ups and referrals, that athenahealth can provide for its customers. 

[Also: Allscripts, Cerner, Epic signal more open EHRs ahead]

“Much of the coding that doctors do is algorithmic in nature and there is no reason why athena couldn't pick up some of that without pretending to have any clinical judgment,” Bush added. “We're experimenting with that kind of work.”

CFO Karl Stubelis added that athenahealth will continue thoughtfully investing in R&D with a focus of working on the existing product right now.

“We're going to get to the emerging products where we're able to capitalize on them in the future,” he said.

As part of athenahealth’s push into the hospital space, Bush said it will probably enter into a new lab, pharmacy or imaging center vertical industry this year, either by acquisition or R&D.

“We are building a national calendar asset and national master patient index. We are working with the major aggregators of retail eyeballs Yelp, and Google and Amazon, so that when this calendar asset is in place, we'll be able to plug it in and doctors on athenaNet will get more appointments than doctors not on athenaNet,” Bush explained. “That work is not yet at the level of a guarantee in market. It's at the level of early R&D today, and hopefully in 2018 we'll be talking about that.” 

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Shares of Athenahealth are still struggling to make up ground after the company’s stock price fell 17 percent on disappointing earnings, and CEO Jonathan Bush said President Donald Trump is partly responsible.

The health IT company said its first-quarter revenue fell because a lower number of doctor visits and reduced reimbursements pushed down claims and collections, prompting its stock price to bottom out at around $96 a share Friday. 

As of noontime Tuesday, shares were still trading around $99 apiece, still nearly 20 percent lower than the roughly $120 a share they were trading at before Friday’s earnings release.

[Also: Jonathan Bush: Athenahealth relishes 'stealing patients']

In the Friday investor call, Bush said that all the uncertainty around healthcare legislation has bad for business, and that comes back to Trump.

“I believe some of this is the national breath-holding around what's Trumpcare going to be and some of this is the continuing rise of deductibles,” he said.

But the CEO, known for making bold statements, rising deductibles sting most at the beginning of a calendar year.

“Deductibles every year having materially larger share – beneficiaries with high deductibles have an increasingly higher share of the covered base, and so they’re increasingly sheepish about going to the doctor, particularly in Q1 when everybody’s deductibles are refreshed,” he said.

Athenahealth posted a first-quarter loss of $1.4 million, or 3 cents a share,  compared with a loss of $800,000 in the same period last year.

“We understand what it means for our shareholders when reviewing our (execution) against our financial and operational goals,” Karl A. Stubelis, athenahealth’s CFO, said during the earnings call. “And we’re not satisfied with our performance in the first quarter and we are challenging ourselves to set expectations that we are confident we can deliver on this year.”

On April 25, Bush sold 8,000 shares of athenahealth stock for about $120 per share in a pre-scheduled transaction that netted him $960,000, according to an SEC document.

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Small hospitals made for the majority of new business for Cerner this past year, according to a new KLAS report, due to the popularity of its easy-to-use CommunityWorks platform.

In fact, the KLAS report found many technology vendors are shifting strategies to the community hospital space, as providers with fewer than 200 beds accounted for nearly 80 percent of EHR buying decisions in 2016.

[Also: Jonathan Bush: Athenahealth relishes 'stealing patients']

Epic continued its market growth, too, but mostly with larger hospitals and integrated delivery networks. More than half of IDN contracts went to Epic in 2016, according to KLAS. About one-quarter opted for Cerner, however, and one of those network contracts was for a consortium of 30 "microhospitals" of fewer than 15 beds, according to KLAS.

In general, small hospitals are recognizing the need for reasonably priced interoperability with proliferating Epic hospitals, the report showed, and many smaller facilities have also contracted for Epic's Community Connect tool to enable that.

Another development in 2016 was athenahealth's continued foray into the acute space since entering the market in 2015. The Watertown, Massachusetts company more than doubled its hospital clients, with one-third of them having more than 25 beds. KLAS says the new customers like the agile cloud-based platform, unique cost structure and inpatient/outpatient integration.

Still, the report suggests that perceived functionality gaps among ancillary departments could have some hospitals looking elsewhere, and KLAS said it will be looking for further evidence of sustainability for athenahealth's scaled-up hospital efforts.

For more traditional community hospital vendors MEDITECH and CPSI, the news in 2016 wasn't so rosy. The former company did gain 17 new hospital clients, but of its legacy customers that made a purchasing decision this past year, more than half opted for a new vendor. Most of them cited insufficient development and skepticism that the technology will be able to meet their future needs, according to KLAS.

Meanwhile, about half of the hospitals that replaced either CPSI's Evident or Healthland platforms opted to go with athenahealth, looking for better usability and support, the report showed.

Other EHR vendors in the KLAS report included Allscripts (retention and wins meant a net gain in 2016, its clients citing "strong functionality with some gaps"); eClinicalWorks ("very little movement … lost key inpatient development customer in 2016"); MedHost ("slight decrease in overall acute care market share") and McKesson ("many users feel Paragon does not meet their needs, and many are uncertain about its future due to McKesson’s plans to sell it").

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

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Verato on Tuesday released its Universal MPI, a master patient index hosted as a cloud service that hospitals can subscribe to instead of managing their own patient matching information and processes.

The company said the Verato Universal MPI, which is pre-populated with patient data, can serve as a hub of sorts that healthcare providers essentially plug into through standard APIs to validate and resolve patient identities, exchange medical records, reconcile patients across various EHRs and reduce duplications.

[Also: ONC launches $75,000 patient matching algorithm challenge]

Former U.S. CTO Aneesh Chopra said in a statement that patient matching is among the most vexing interoperability issues. And without a federal policy change that would allow national patient identifiers, the healthcare industry is struggling with consistency and accuracy of patient records.

“Even as EHRs begin to support patient access to their health information, most providers are reluctant to deploy the technology without greater confidence in the patient and record matching,” said Chopra, who is now President of NavHealth.

Verato said the Universal MPI is pre-populated with demographic data that spans the U.S. population and features a referential matching technology to link identities in new ways.

And every healthcare provider that plugs into it will also be able to resolve patients with other hospitals that participate in the Universal MPI.

Verato CEO Mark LaRow claimed that the current generation of MPI technology already ran up against its limits when it comes to probabilistic matching algorithms and the healthcare industry needs an entirely new approach.

“Our idea was to solve the patient identity problem by harnessing big-data and applying data science expertise at a level that would be inconceivable for any individual enterprise,” LaRow said. “And then offer our solution to everyone.”

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

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All options are still on the table for VistA’s future, including the adoption of an off-the-shelf EHR or working with a commercial vendor able to support the outdated EHR, Department of Veterans Affairs Secretary David Shulkin said Wednesday.

But one choice is cheaper than the other.

Shulkin told the U.S. House of Representatives Committee on Appropriations that the VA is considering a commercial off-the-shelf option, but if they opt to forgo working with an outside vendor to modernize VistA, the VA will need more funding to replace the system.

[Also: Open source experts to VA: Keep VistA, it can be fixed]

“We’re exploring all options,” Shulkin said. “The problems in the VA aren’t financial. These are systemic issues that haven’t modernized -- the IT system is one example.”

Also top-of-mind for the committee was EHR interoperability with the Department of Defense.

“It’s my understanding the DoD has already rolled out the system. In order to ensure interoperability… what’s wrong with the DoD’s system?” Rep. Nita M. Lowey (D-NY).

[Also: VA hospitals outperform mainstream facilities on readmissions, mortality rates]

Interoperability is a highly complicated issue for an agency the size of the VA. Since many veterans use private sector healthcare providers, the system needs to be interoperable with those systems as well, said Shulkin.

“If there was an easy solution, I’m sure it would have been made already,” said Shulkin. “[Congress] has asked DoD and VA to work together for 10 to 15 years, and we’ve always found ways not to. [DoD Secretary] Mattis and I believe we need to find ways to work together.”

The VA has learned the hard way and has taken far too long to make decisions. And the system has multiple flaws. Shulkin said he is open to all ideas and will take any path forward that works best for veterans.

“IT has to be a core competency of any organization nowadays,” said Shulkin. “We don’t want to be in the development business, but managing systems are a competency of any business.”

To best serve veterans, the VA needs to work with a core group of VA staff, while considering private sector accomplishments and apply that knowledge to the agency, said Shulkin.

“I’m only here for one reason, and it’s to solve the problems that have plagued VA,” he said.

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

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