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    WellSpan Health, an integrated health system in south-central Pennsylvania, alerted its patients to possible delays last week before it went live with its Epic electronic health record system on May 5.

    But while the organization expected longer than usual wait times as staff made the transition at all WellSpan locations in Lancaster and Lebanon Counties -- it may have been an unnecessary warning.

    “We went live on a Friday, and of course there was the chaos of going live everywhere,” said WellSpan Senior Vice President and CIO Hal Baker, MD. “But we had the weekend to figure out how to be better prepared for Monday.”

    Epic was nervous about the choice to launch the system at the end of a week, but it really worked out, he said.

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

    Baker’s team of ambassadors have handled possible disruptions, but the roll-out went as smoothly as possible. He attributes the success to the governance established well before Friday’s go-live.

    “We put together power teams across all of WellSpan’s divisions, sectors and regions, with a tremendous amount of standardization,” Baker said. “We’ve also had good communication. The greatest surprise to me is the degree to which the project has aligned leadership teams to view each other as part of the same operational family.”

    The health system hired a dedicated communication person a year before go-live to handle staff readiness and assessments. Operational leaders handled training and helped staff to practice with the system in preparation.

    “It’s not an IT project, it’s an operations and clinical project,” said Baker. “It’s been a great aligning of two communities, and we’re much stronger as a result.”

    WellSpan has more than 130 locations throughout Pennsylvania, and although Baker said the organization had successful systems in place prior to the switch, he realized the organization was not as connected as it could be.

    “We recognized that we couldn’t function as one complete system, if we had multiple records and systems in place,” Baker said. “We called it ‘Project One,’ not for its prioritization, but as it’s about one organization.”

    WellSpan made the decision to switch its entire system to Epic in 2014, and spent the following years preparing for the move. The estimated cost is $188.7 million over three years. The hope is for providers to better connect with patients and improve care coordination.

    The goal is to have all WellSpan locations switched to Epic by Oct. 20, said Baker.

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    Modernizing Medicine, which makes a mobile-based EHR for specialists, has raised $231 million from global private equity firm Warburg Pincus. The company has raised funding a number of times before, so this raise takes its total funding to $318 million.

    “We expect this infusion of capital from Warburg Pincus to be instrumental in advancing our mission to transform how healthcare information is created, consumed and utilized to increase efficiency and improve outcomes,” Daniel Cane, CEO and co-founder of Modernizing Medicine said in a statement. “Warburg Pincus brings deep experience in the healthcare technology sector and this investment can help further our growth, bolster innovation and support our clients.”

    Modernizing Medicine has distinguished itself from other mobile EHR systems, and from legacy EHRs, in a number of ways. Most notably, it focuses on catering to the specific needs of medical specialists, including dermatologists, ophthalmologists, orthopedists, otolaryngologists, gastroenterologists, urologists, and plastic surgeons. In order to understand those needs, the company hired practicing physicians to work with engineers to build the technology. The company also bolstered at least one specialty through M&A, acquiring gastroenterology tech company gMed in fall 2015.

    Additionally, Modernizing Medicine has a focus on AI, using aggregated, deidentified data to create population-level insights that are then delivered back to the physician. The company was also working in 2015 on developing a new app as part of IBM Watson's ecosystem project, called schEMA. The new app would build on the work EMA does with aggregated EHR data, but add in Watson's ability to parse unstructured data, to give medical specialists the best data on treatment options for their patients. According to a spokesperson, the company is no longer actively pursuing the app for commercialization.

    "Modernizing Medicine continues to explore how cognitive computing can play a role in healthcare," a representative wrote in an email. "Its schEMA application made for an exciting proof of concept, but the company felt that it still need to mature further before it would be commercializable."

    Lately Modernizing Medicine has been expanding beyond core EHR functions to offer practice management, revenue cycle management, telehealth for dermatology, analytics, and more. With the new funding, the company plans to add more features including automation of prior authorization workflows, deployment of an eCommerce platform, data interoperability, and additonal telemedicine features.

    Fred Hassan, managing director at Warburg Pincus, and Amr Kronfol, principal at Warburg Pincus, will join Modernizing Medicine's board of directors. In addition to the development of new features, the funding will be used to expand operations and provide liquidity to shareholders.

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    Epic Systems founder and CEO Judy Faulkner is No. 6 on the 2017 Forbes list of richest self-made women, logging a $2.5 billion net worth.

    Faulkner built the electronic healthcare record company from scratch, starting in a Madison, Wis. basement in 1979 with a $70,000 investment. The company moved to its current location in Verona, Wis. in 2005.

    [Also: Epic CEO Judy Faulkner opens up about why she's talking to reporters these days]

    Today, she employs more 9,500 people on a sprawling and ever so artsy and whimsical campus. Among the many theme-park-like features are a slide to get from one section of the building to another and a also what appears to be a “stairway to heaven.”

    All the quirky campus touches aside, Faulkner runs a very serious enterprise, supplying multi-million dollar EHR systems to some of the most prestigious healthcare organizations in the country. Among them are Kaiser Permanente, Cleveland Clinic, UPMC and Partners HealthCare.

    [Also: Epic reveals R&D spending outstrips Apple, Google and its competitors]

    Faulkner has pledged to give away her fortune via the “Giving Pledge,” a promise also made by billionaires Warren Buffett and Bill Gates, among others.

    On this most recent Forbes list, Faulkner is listed a few notches down from fellow Madison, Wis. self-made woman Diane Hendricks, who took the No. 2 slot, with a net worth of $4.9 billion. Apparently, there’s more money to be made in roofing than in EHRs. Oprah took the No. 3 spot.

    However, Faulkner placed well ahead of celebrities such as Celine Dion, Barbra Streisand, Beyoncé, Madonna and Judge Judy.

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    Electronic health record system conversions are one of the largest undertakings an organization can undertake, and Epic go-lives are famous for sometimes going wrong.

    However, Kevin Johnson, MD, thinks that doesn’t have to be the case.

    “Every EHR install tests the entire structure of an organization, such as governance, accountability and communication skills,” said Johnson, who is vice president for health IT and chief informatics officer at Nashville-based Vanderbilt University Medical Center.

    [Also: WellSpan Epic EHR goes live without a hitch]

    Johnson, who is the EHR project leader of Vanderbilt’s conversion, is focusing on three core components to successfully launch its Epic EHR in November: people, process and technology. And technology is the smallest concern of the three.

    “It’s almost invariable when people have challenges with their Epic, Cerner and Athenahealth installations that people and process issues are at the core,” said Johnson.

    Training, communication and governance

    While it’s difficult to compare installations, there are core functions of the organizational structure that can make an install easier. Vanderbilt’s 120 clinics and outpatient sites are focusing on unique training techniques for its 19,000 employees to bolster the rollout.

    Training consists of a combination of e-learning, view-only use and some basics available on the users’ own time. Epic also provides face-to-face training and a sandbox that allows users to play around in the system to see how it would function in their environment.

    Vanderbilt also worked with Epic to install “space stations” for more hands-on training. The system helps users understand their role and how the platform functions on different devices.

    Training is also broken down by specialties, so users are only focusing on elements relevant to their role.

    Johnson is most excited about Vanderbilt’s innovative Hubbl mobile app built into the environment, which helps all staff involved with the project to communicate. There’s a countdown to the platform launch, training materials, workflows and user-specific task-lists related to the project.

    “All the data is sent back for an analytics process,” said Johnson. “It’s a multi-pronged approach.”

    More than 1,500 Vanderbilt employees have been contributing to the design and validation process, through over 1,000 adoption sessions. Johnson said these users can look at the platform and provide input.

    “Employees have brilliant questions” that can only help with the system development. The idea is to incorporate these ideas the right way to make sure staff and clinicians “don’t get burned out.”

    There’s also another 80 to 100 people who function as ambassadors. Johnson said their primary role is to learn the ins-and-outs of the system to be able to answer any potential questions from employees.

    A governing structure that runs from the ground-level all the way to the CEO works with Johnson to help alleviate any concerns. Johnson said it helps ensure all voices are heard and all projects are properly prioritized.

    Collaboration is crucial in EHR installation

    Vanderbilt is also banking on the experience of other organizations to ensure its own success.

    Johnson and his team have spoken with IT departments of larger medical centers like Duke, Johns Hopkins, the University of North Carolina, Partners and Mayo to see what went well during their EHR installations and conversions -- and to make sure Vanderbilt is on the right page.

    “We also want to see where we can improve,” said Johnson. “We can all learn from each other.”

    One major piece of advice Vanderbilt has gained during this project is to “make sure you understand the process issues and understand who owns each process.”

    “Involve users as real owners of implementation, so they know what the implementation will do to current processes and ensure they have the support to manage these changes appropriately,” said Johnson.

    Vanderbilt is known for its technology development work. And for Johnson, projects like Hubbl can benefit other organizations.

    What Johnson’s team has learned during its implementation and collaboration process is that, from a technology perspective, “it’s far easier to implement Epic all at once. It’s always a bigger challenge to bring up pieces of a system, as it’s not designed as well to be seamlessly integrated.”

    The medical center is also using the project to work with Epic on building components that both organizations feel would help other users. One example is inpatient alerts and adding research electronic data capture information that can be used both in and out of Epic. That announcement is expected sometime later this year.

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    Healthcare IT giant Cerner and Truman Medical Centers in Kansas City are working together to create disease management programs that employ patient monitoring technology in patients’ homes.

    Algorithms configured in Cerner’s HealtheIntent population health management platform identified select groups of TMC’s patients with conditions such as diabetes and chronic heart failure who might benefit from health monitoring at home.

    Cerner’s HealtheIntent technology aggregates and analyzes participants’ health information and sends automated alerts in near real-time to help TMC care teams intervene when they observe data patterns that concern them. Program participants are connected to remote patient monitoring with medical devices that are joined to their electronic health records. The goal, TMC executives say, is to engage patients in their health and improve outcomes.

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

    “While providers deliver care in traditional healthcare settings, health crises or situations typically occur outside of this setting, like their home, workplace or in the community,” Ryan Hamilton, senior vice president of population health at Cerner, said in a statement.

    “We joined this strategic relationship with Cerner to research and develop opportunities to improve the health of our population,” said Mitzi Cardenas, senior vice president and chief strategy and information officer at TMC.

    Cardenas noted that diabetes and chronic heart failure are not only common, life-threatening and costly diseases, they are also preventable. The goal, as she sees it, is to engage participants in their care, achieve better health and prevent hospital readmissions.

    The pilot could lead to the expansion of similar remote patient monitoring programs at TMC and across the healthcare industry.

    In October 2015, TMC and Cerner entered into a strategic relationship called KC one. The initiative aims to transform healthcare across Kansas City, tackling questions such as how to lower costs, enhance quality of care and boost patient safety.

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    The U.S. Department of Veterans Affairs is continuing its overhaul of the agency and has awarded Document Storage Systems a $19.6 million contract for an off-the-shelf patient self-scheduling system through a mobile app to improve veterans’ access to care.

    DSS is a health IT provider for federal, private and public healthcare agencies and currently works with the VA on numerous IT projects.

    The latest contract will support the Faster Care for Veterans Act of 2016, which requires the VA to establish an 18-month trial program from which veterans can use any mobile device to schedule and confirm primary care, specialists and mental health appointments.

    The Mobile Veterans Appointment Request tool, which is currently available at 99 VA healthcare sites, is modeled after other private sector patient scheduling apps. Officials said the VA will continue to incorporate new capabilities into the platform.

    [Also: Everybody hates VistA? Not its users]

    The app is fully integrated with VA’s VistA electronic health record. Officials said it incorporates alerts to identify and prevent potential scheduling issues, by indicating require prerequisite services for each patient. Patients can also manage both in-person and telehealth appointments through the app.

    VA has been under fire for scheduling issues stemming from a 2014 scandal that revealed employees and managers were hiding the length of time patients were waiting to see a provider.

    As a result, the VA, under Secretary David Shulkin, MD, is working toward the modernization of the entire VA network. Shulkin said he’ll decide on the fate of its outdated VistA EHR by July. He’s a vocal proponent of leveraging “innovative tools that will put more capabilities in the hands of veterans.”

    “Self-scheduling apps are widely used in the private sector and will help create a better experience for Veterans and their medical-care providers,” Shulkin said in a statement.

    “Patient self-scheduling is a core solution that addresses the fundamental challenge of providing the right access to care,” DSS President and CEO Mark Byers said in a statement. “This allows Veterans to feel like true partners in their care processes.”

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    Investment firm Elliott Associates has bought 9.2 percent of athenahealth stock, according to an SEC filing submitted Tuesday, and speculation has already started about what that might mean for the health IT company’s future. 

    For starters, athenahealth’s stock jumped 8 percent Thursday morning on the news.  

    According to the SEC filing, Elliott Associates described athenahealth stock as an attractive investment opportunity because it is currently undervalued. 

    [Also: Athenahealth stock struggling after poor earnings; Bush partly blames Trump]

    "There are numerous operational and strategic opportunities to maximize shareholder value and the holder will be seeking to engage in a dialogue with the company's board regarding these matters,” Elliott Associates stated. 

    TheStreet reported this morning that, for Singer, “strategic opportunities usually mean find a buyer and sell the business.” 

    Elliott Advisors just last week, for instance, pressed Dutch paint maker Akzo Nobel to enter takeover talks with US rival PPG Industries, and soon after began legal proceedings to try to oust the company’s chairman, according to reports.

    “We are aware of Elliot’s filing and look forward to talking with them to hear their views about the company and discuss the actions we are taking to drive enhanced growth and value creation for all athenahealth shareholders,” athenahealth director of PR Holly Spring said. “We have great confidence in the company and where we are headed.”

    In an investor call earlier this month, athenahealth co-founder and CEO Jonathan Bush said the uncertainty around healthcare legislation had been bad for business, and he blamed that on President Trump. 

    Founded in 1977, Elliott Associates today manages more than $32 billion in capital for both institutional and individual investors. The firm describes itself as a multi-strategy firm, active in debt, equities, commodities, currencies and various other asset classes across a range of industries, especially in technology.

    An Elliott Associates spokesman declined to comment beyond what it had reported in the SEC filing.

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    The rise of electronic health records with natural language processing technology is transforming provider workflow and clinical documentation.

    Though NLP is not without its challenges, it can offer valuable benefits when used wisely, said Anupam Goel, vice president of clinical information at Chicago-based Advocate Health Care.

    While NLP can offer advanced diagnostic benefits, it depends heavily on the specifics of how clinicians enter their documentation, Goel said this week at the Healthcare IT News and HIMSS Big Data and Healthcare Analytics Forum in San Francisco.

    [Also: Epic, Nuance embed AI into EHR for clinical documentation improvement]

    The moment is ripe for NLP-enabled charting, he said. The technology has sufficiently evolved to be useful rather than counterproductive, and the benefits – ease-of-use, a shorter window between clinical documentation and the activation of care teams – are clear.

    Goel said he expects more clinicians will be using voice commands to log data rather than filling out forms. NLP is useful for identifying clinical gaps, he said, and can help organizations reduce labor costs.

    That said, "there are lots of ways NLP can screw up," he said.

    NLP enables misinterpretations related to both content (the acronym "SOB" has a different denotation in a clinical setting (shortness of breath) than it does in common parlance, for instance) and context (it could miss crucial distinctions between family history and personal history in a patient's EHR).

    "This is the reality of NLP," said Goel. "If you can set expectations low, you'll be better positioned for success in the future."

    NLP is an algorithm, and it depends intrinsically on the input and corrections it gets from its users to improve over time, he said. "It's not perfect out of the gate. It's a tool that is going to evolve and get better as you feed it more information."

    Vendors of NLP technology are focusing most these days on clinical documentation improvement for more complex diagnoses, real-time feedback for better-quality charting and improved billing accuracy.

    "That's all got great value," said Goel.

    A more complex deployment of NLP – but the one with the "most potential for healthcare," he said – is to link it with rules engines to help with decision support.

    Doing so can enable providers to more easily flag specific data for review, route certain assignments to condition-based worklists or suggest certain treatment courses.

    But getting it right is not necessarily easy. And it depends heavily on physicians and clinical staff following best practices.

    The risks for NLP from a clinician's perspective include "too little information," said Goel.

    The more data for the technology to make use of, the better. Minimal documentation limits the algorithm's ability to separate "wanted" from "unwanted" cases, he said, adding that cases that are difficult for humans to distinguish will likewise be hard for NLP programs to make sense of.

    As he highlighted NLP systems such as R+OpenNLP and Apache cTAKES, Goel said natural language algorithms hold big promise for targeted case-finding and streamlined clinical efficiencies.

    He suggested beginners bolster their NLP proficiency by first deploying it in "low-risk scenarios," that could help build up confidence in the tools while avoiding the risk of adverse events.

    He also cautioned that smart integration of NLP with clinicians' workflow is critical to realizing any productivity gains. 

    "If you don't integrate it with workflow, you're just creating more work without more value.”

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    Remote patient monitoring is on the rise, but the challenges to flowing outside data into existing electronic health records are substantial. In the Journal of AHIMA, Kapila Monga, associate director of healthcare analytics at Cognizant Technology Solutions spotlights five key areas health information management professionals should stay focused on to optimize the integration of remote device data with electronic health records.

    Data integrity. It's critical, of course, that HIM staff determine "if, where and how" the myriad types of real-time device data – heart rate, oxygen level, blood pressure, glucose – be streamed in the EHR system, said Monga. But just as important "is the traceability of information back to point of collection," she said. Some of that challenge will be solved by technology as EHR systems evolve to accommodate the new imperatives of telemedicine. But HIM professionals will always have a central part to play when it comes to ensuring that remote health data is helping provide better care "without compromising the integrity of the EHR."

    [Also: Hospitals can make medical devices up to 70% safer, Mayo exec says]

    Information usage. Connected health devices have one job: transmitting patient information back to the provider on a near-constant basis. It's up to HIM pros to figure out just when and how all that data will be put to work. As "gatekeepers" of this information, they're key to determining just what rules and alerts will be brought to bear on this massive stream of information, helping clinicians set up the right protocols, depending on the patient. "A sudden increase in sugar level for a non-diabetic person might not be an alarm, and could be just attributed to a sweet indulgence on the part of the individual, while the same spike in blood sugar for a diabetic patient could be a call for action," said Monga.

    Confidentiality. For all the potential clinical benefits of real-time 24/7 data streaming, it's "a ticking time bomb when it comes to data security." HIM staffers may not be the first line of defense when it comes to privacy and security, but they'll be key collaborators with infosec colleagues to create "proper protocols for how and when to analyze the information, how to identify and receive relevant information, and how to dispose of information when needed after analysis," said Monga.

    Lifecycle. The profusion of Bluetooth-enabled glucometers, remote blood pressure devices and more, all streaming varied and voluminous data, have hugely complicated the job of information management. "HIM professionals typically oversee the accuracy of health data, facilitate/perform audits, and facilitate information retrieval," said Monga. "They will have a very critical role to play in terms of designing protocols for managing the lifecycle of connected health data/patient monitoring data, including a role in audits of the health data, and in augmenting and supporting patient care."

    Governance. As the rules and regulations around connected health and its reimbursement continue to evolve – state by state, health plan by health plan – it's incumbent on HIM pros to "continuously update themselves on the legalities surrounding the usage of this data, as well as on reimbursements to provider systems for providing and monitoring care using this technology," said Monga.

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    Athenahealth is stepping into Silicon Valley with its new More Disruption Please Labs, a planned day targeting startups that hopes to give them an audience with 200 health IT superstars.

    “MDP Labs’ goal is to attract developers and entrepreneurs, and support and fast track the ‘best-of-the-best’ solutions onto athena’s cloud platform,” MDP Labs head Santosh Mohan said. “We want to foster a culture of innovation, fearlessness and agility, and work with like-minded entrepreneurs.”

    That will essentially kick off on June 13, when athenahealth CEO Jonathan Bush intends to hold a ‘reverse pitch day’ in the new San Francisco facility. The idea being that Bush will pitch interested digital health startups on the largest opportunities and hardest challenges athenahealth faces, according to Mohan.

    “We placed MDP Labs in San Francisco -- a prime market for internet-based entrepreneurs -- to join our collective efforts,” Mohan said.

    The health IT innovators and entrepreneurs that athenahealth chooses will earn office space, workshops and related events, as well as what Mohan described as unrivaled exposure to the company’s R&D team, senior leadership and a mentor network.

    “This is a nationwide call inviting health IT innovators from to apply to join us here in San Francisco to build innovation in health IT,” Mohan said.

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    Since the news broke May 18 that investment firm Elliott Associates scooped up a nearly 10 percent share in athenahealth, rumors have been rampant that its founder and well-known activist investor Paul Singer may be eyeing the cloud-based healthcare technology vendor as its next big deal. And that likely means a sale or merger.

    “Athenahealth is an attractive target, especially at its current valuation -- a discount to other software companies that are growing at a similar pace,” according to a piece by columnists Max Nisen and Gillian Tan that appeared in Bloomberg.

    Athenahealth posted a net loss of $1.4 million for the first quarter 2017. What’s more, rival Epic Systems is apparently taking aim at athenahealth’s market position with the two forthcoming lower-cost versions of its EHR that Epic CEO Judy Faulkner revealed at HIMSS17 in February.

    “Athenahealth’s time as a public company has been marked by extreme volatility and frequent disappointment,” the columnists said.

    They listed Cerner, IBM, insurer giants UnitedHealth Group and Aetna, and even Epic as several possible suitors.

    But just about a year ago, Epic founder and CEO Faulkner told Healthcare IT News she was not inclined to acquire companies or technology, preferring to build from scratch. She wanted to avoid the growing pains of acquiring and then trying to integrate companies and technologies. Though, these kinds of things can and do at times change. 

    “Elliott has made a cottage industry of prodding underperforming software companies into action, including outright sales,” the Bloomberg authors said. “If that's the game plan here, then Athenahealth shouldn't have too much trouble finding a buyer.”

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    As of March, Penn Medicine is live on Epic enterprise-wide, wrapping up what has been an almost decade-long process.

    Penn began rolling out Epic electronic health record at its ambulatory sites as far back as the late '90s – finally completing the outpatient implementation about seven or eight years ago. In March, the academic medical center switched on its inpatient, hospital billing and home care systems. 

    That has required a bit of a balancing act when it comes to ensuring physicians and nurses are using the EHR to the best of its capabilities, said Scott Schlegel, associate vice president for EHR transformation at Penn Medicine.

    "Basically we were living with two different worlds," he said.

    At first, the idea with the ambulatory implementation was to eventually transition staffing and resources to post-rollout EHR optimization.

    "But we never really stopped implementing: We continued to implement and we never got around to optimization," he said. "So the problem that we had was that our physicians were never really trained after they got their basic training and they developed good or bad habits individually."

    One of the key tasks for Schlegel's team was "to do some remedial work to tighten up on the ambulatory side – the ones that have been live for a little while – and then mesh that with the newly minted users on the inpatient side."

    So far, that work has been going very well, he said. His team comprises so-called advanced provider educators who focus on targeted efforts to ensure clinicians are using the EHR optimally.

    "We've been tasked to create optimization infrastructure, and a transformation infrastructure, that leverages the EHR to help us achieve our business goals and clinical care goals," said Schlegel. "Those are our marching orders."

    Good governance is key

    As is often the case, a sound strategy is essential to make such outreach work: "We have a very strong governance group, and we set our optimization efforts around those governance-set priorities and needs," he said.

    "Because our EHR is the backbone of basically everything we can get done on the operations side, we leverage other groups that are already in place. They may be quality groups, they may be existing policy governance groups or enterprise governance groups."

    Schlegel's colleague Philynn Hepschmidt said it's critical to have a balance of stakeholders at the table for any successful optimization outreach.

    As associate executive director of EHR integration and clinical optimization, Hepschmidt is charged with making Epic work well across Penn Medicine, teaming with various leadership across the organization to come up with strategies for better IT use.

    With those groups, "there's a mix of clinical folks and non-clinical folks," she said. "They don't sit in IS. You have a mix of operations and clinical people at the table."

    Schlegel said a three-part balance – "a physician, a nurse and an operations person" – had been extremely valuable to crafting smart optimization strategies that meet the needs of the specific staffers.

    Crucially, he said, the efforts are led by the operations department – in close partnership with information services – and are focused both on improving both individual usage of Epic and enterprise-wide functionality challenges.

    "One of the uniquenesses with us is that we do not sit in IS," said Schlegel. "We sit in operations but partner very closely with IS."

    He said there were some "challenges that were unique to us in the beginning," with regard to "sorting out what role people had, and where we draw lines and things like that."

    He sees the optimization team as "a bridge between operations and IS," allowing each to play to its strength while maximizing the chance that EHR optimization efforts will stick.

    "We've sort of helped facilitate that by pulling various groups together to leverage the existing infrastructure to get some stuff done," he said.

    Hepschmidt says one recent innovation at Penn Medicine is to do pop-up "genius bars" where any troubleshooting question is on the table.

    "The topics are focused on the things we can do right then and there – quick action tools, quick filters, other things to help speed things up for them, in terms of searching for information in the chart," she said. "They've gotten some questions about reporting. I think that's a big complicated thing here at Penn: how to get data and where to get it from."

    The team is considering teaming up with Penn's Faculty Wellness Committee, which runs a project with a similar concept, said Schlegel. "So one day we may have, 'How to best use your Outlook email.' And then another day it would be an Epic-focused one, where we would explore how to use quick actions, or how to use your mobile app."

    Extracting value from expensive systems

    Schlegel says EHR optimization is important for many reasons, especially when it comes to getting clinical and financial returns from some very expensive IT systems.

    "One of the things we have struggled with – and I think a lot of places struggle with – is with our senior leadership saying, 'Show me the value of this investment.' We invested almost $200 million in Epic, and we're not alone there, I know. So what do we get from it? Some folks might just regard it as the cost of doing business. But our (execs) are really pushing for how do we leverage this system to get some of that money back."

    Some of that ROI can be achieved right away, of course, "with the normalization and standardization of workflows," he said. But Penn Medicine wants to go well beyond that.

    "My background is in practice administration and I work very closely with physicians – with, how can we measure your improvement in productivity or charting efficiency or something like that, as a result of our intervention," said Schlegel. "How do we make you happier? How do we shorten your day and help you make it to your soccer match without having to worry about charting at 10 o'clock at night."

    So Penn Medicine uses Epic's provider efficiency data, which tracks nearly everything a physician does in the EHR.

    "Our trainers will look at that prospectively and figure out, you can easily see who's logging in at 10 o'clock at night and closing their chart," he said. "This was a very popular thing. It doesn't represent more dollars, per se. But in this day and age, with providers feeling more and more put-upon, this was included as a faculty wellness activity.

    "Now we're getting some pressure to go a little further and really identify some process measures that we think are helping – and we're using that PEP data to drive that," he added.

    One doesn't have to be at a large and well-resourced academic medical center to embrace optimization projects such as these. Even those providers with more modest staff sizes could pursue similar initiatives on a smaller scale.

    "We started with a very small group," said Schlegel. "We began with four, added two eventually, and then added more as we went on. We did a little leg work to try to figure out what the top clinician complaints were, at first, then we supplemented that with data, which was fairly doable. You could just as easily do this in a practice of five or 10 people."

    Whatever the size of the provider organization, the importance of EHR optimization efforts has to be communicated to C-suite and clinical staff alike, he said.

    "We said, 'This is as important as passing a Joint Commission audit, or the next Medicare mandate that comes down the road.' And I think our organization did a pretty good job of recognizing that and escalating it.”

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    The Department of Veterans Affairs has been under fire for years for its electronic health record VistA and the lack of interoperability with the Department of Defense’s EHR and other systems.

    But while VistA may have its flaws, the VA and others insist that interoperability is not one of them.

    “VA is a pioneer of interoperability,” said DSS Senior Health Informatics Consultant Deanne Clark. “VA continues to surge forward with interoperability with DoD, private sector and community care providers.”

    A prime example? In 2009, the VA began data sharing with massive integrated health provider Kaiser Permanente -- which runs on Epic. The agency also works with hundreds of hospitals and thousands of clinics. 

    [Also: Congress presses VA secretary on VistA interoperability, costs]

    VA runs health exchanges through its Virtual Lifetime Electronic Record initiative, which encompasses the use of VA Exchange and Direct Messaging. Combined, the programs have partnered with about 250 healthcare organizations that connect with about 850 hospitals and thousands of clinic practices nationwide for about 1 million veterans.

    Veterans can opt into the program, which connects their patient data to a long list of health providers like Walgreens, Mercy, University of Virginia Health System, INOVA Health System, Maine HealthInfoNet, Allina and Cedars-Sinai. 

    Vermont’s HIE is now connected to VA. And in New York, Rochester-based Canandaigua VA Medical Center has begun to share data with the Statewide Health Information Network for New York.

    Possibly one of the greatest testaments to how ingrained VA is in the health community is its work with open source. VA established the Open Source EHR Record Alliance as a means to collaborate with other organizations. Much of VistA’s software has been in the public domain for years, and Vista-based products are available around the world.

    [Also: Everybody hates VistA? Not its users]

    “OSEHRA has been working with VA to come up with a standard VistA code,” said OSEHRA President and CEO Seong Mun. “Some of the standardized VistA has come into the private sector.”

    Another new project is its Joint Legacy Viewer: a planned replacement for VistA Web. Clark explained it’s designed to further improve VA and DoD interoperability. In conjunction with the VA’s replacement, DoD is decommissioning its similar programs and replacing it with JLV.

    Some 240,000 VA users have access to the program and more than 3 million records have been viewed through it as of early 2017.

    “JLV should prove to Congress that VistA is capable of meeting interoperability requirements for data sharing with DoD and speak to the robust nature of the VistA platform,” Clark said.

    For decades, the agencies attempted to connect, working together on an integrated EHR formerly known as iEHR that ultimately disbanded. What followed was finger pointing and Congressional chastisement.

    Then, when the DoD announced it would update its unpopular and outdated EHR system with Cerner, the blame began to shift to VA for interoperability issues. But while Clark admitted that there are definite struggles between VA and DoD, “the balance today falls on the lack of DoD to share data with the VA.”

    While Congress tends to compare the agencies, VA and DoD are staunchly different in size and function. DoD provides care for a less diverse population, is smaller and patients aren’t treated as long as they are within the VA. Further, many of the patients seen within the DoD end up at the VA, and there are differences in the types of services offered.

    So what will it take for the DoD and VA to finally become interoperable?

    “A unified vision and priorities for both agencies,” Clark said. “There’s been a lack of ability to sustain a constant direction with the influx of leaders and it affects the continuity of development over time.” 

    VA Secretary David Shulkin, MD shared similar views with the U.S. House of Representatives Committee on Appropriations on May 3: 

    “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.”

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    VA Secretary David Shulkin is currently in the process of deciding among electronic health record alternatives for the future. Here are the main aspects VA should take into account when making its pick.

    Department of Veterans Affairs Secretary David Shulkin has committed to a decision about the use of a commercial approach to the VA’s electronic health record by July of this year. Several options are under consideration including: 1) using a commercial vendor to develop and maintain the Veterans Information Systems and Technology Architecture (VistA) electronic health record and provide VistA back to the VA using a Software as a Service (SaaS) model or 2) purchasing a proprietary commercial-off-the-shelf (COTS) electronic health record.

    Using my perspective of more than a decade of support to various parts of the VA, work in the open source software community, and my broad health IT domain experience, I have looked at this choice from eight different business case perspectives.

    Software Acquisition Cost
    The software acquisition cost for open source VistA maintained and developed by a commercial vendor is likely significantly lower than a COTS electronic health record solution. VistA is already an open source software product, used by a variety of non-VA healthcare systems including the Indian Health Service, State of New York, a variety of community hospitals and the country of Jordan. Additional modules will be added over time based on open source community development and sharing.

    The acquisition of a COTS electronic health record will likely require billions in software licensing costs across VA (DoD’s initial contract award to the Leidos/Cerner team was $4.3 billion). There will be an additional cost for enhancements and new functionality.

    Time to Value
    For commercial VistA, the value provided to the VA will be nearly immediate as VistA will continue to be used and evolved over time from commercial / open source enhancements. VA can leverage its current software enhancements efforts including initial investments in the electronic Health Management Platform (eHMP) and Digital Health Platform (DHP).

    There will be a long contracting period (with potential bid protests) if the VA chooses to procure a commercial EHR. (For example, after developing the EHR RFP, DoD released its RFP in August 2014, made the award in July 2015, and announced a delay in September 2016. A pilot was finally deployed in February 2017, with full deployment in 2022 – 8 years after the RFP was released.) This will be followed by studies to define change management requirements and address the business process changes associated with the complex transition. New system implementation will likely take 2-3 years to initiate, and 3-5 years to be implemented system-wide. In the meantime, the VA’s current VistA will need to be maintained.

    Build vs. Buy
    The “build” versus “buy” equation is more complex now than in previous years. Forward leaning EHR vendors will offer components and ask VA to build a little. “Builds” that consider use of open source instead of commercial components are more relevant now than they were a few years ago. Value for VA could be obtained from open source and components that compete in the commercial market. The key is to make sure the open source ecosystem remains large and robust to keep pace with required new software. VA’s recent public-private partnership with the Digital Health Platform (DHP) was a good proof of concept. However, to be successful, the VA culture and strategy of open source must become fundamental to VA and the concept of open collaboration with the community must impact the entire information technology lifecycle.

    [Also: Congress presses VA secretary on VistA interoperability, costs]

    Proprietary COTS vendors will push customers to “buy.” Then the customer is generally “locked in” and cannot take advantage of evolving technology available in the marketplace that is not provided by the COTS vendor. Functionality that the vendor does not provide will have to be built by VA or another contractor. The advantage of “buy” is that the VA will be able to easily use software advances developed by the COTS vendors for other customers. The key is to pick the COTS vendor that is the market leader now and into the future. Switching costs in the future are likely to be high.

    VistA provides the functionality that VA requires, which includes functionality well beyond the electronic health record. Nearly 50% of VistA modules enable supporting services at VA that are not directly related to clinical support services typical of commercial EHRs. The VA is also exploring additional Health IT software to address needs including clinical workflow and supply chain management.

    Proprietary COTS health record software currently lacks the enabling services support functionally that VA has built into VistA over the last 40 years. In the future, proprietary COTS may have additional features and functionality that would be useful to VA. As the COTS vendor enhances functionality for other commercial clients, the VA will be able to take advantage of these new features when they are developed. The VA will still be highly dependent on the business decisions made by the COTS vendors based on their technology roadmaps and business positioning in the commercial hospital marketplace.

    Change Management
    Since VistA is already in use at VA and current work is taking place to standardize VistA across all the VA sites, there would be limited clinical or business process changes at the outset and any enhancements downstream will be incremental, requiring a manageable change management process. There will be a cost for change management on the technology side to convert from in-house to commercial VistA support and operations.

    VA currently provides care at 1,233 health care facilities, including 168 VA Medical Centers and 1,053 outpatient sites. VHA has 310,000 employees as of September 2015 (per VHA Workforce Plan 2016). For a proprietary COTS EHR, there will be an extremely high cost for business process change management. There will be a learning curve for physicians, other clinical staff, and administrative support users to become accustomed to the new proprietary solution. Caregiver resistance may be an issue. There will still be a cost for change management on the technology side to convert from in-house to the COTS vendor support and operations.

    Business Operating Risk
    If commercial VistA is chosen, continuity and quality of care will remain high with limited disruption since the supporting business processes and software will not change dramatically. The enabling commercial VistA software will evolve over time with a lower rate of change over a longer period, resulting in minimal business operational impact and lower risk.

    VA’s healthcare system operates as a single provider network for nearly 9 million

    Veterans. Continuity and quality of care could be disrupted due to the substantial clinical business process changes required to use new a proprietary COTS EHR. There is also a significant risk of health care provider resistance to change. Business risk will need to be managed carefully. Additionally, medical data may be located at a commercial vendor owned site, not under direct government control, and the proprietary COTS commitment would be difficult to exit from or change in the future. (For example, in 2016, DoD awarded Cerner an additional $50.7 million for data hosting after competitor appeals were lost.)

    Software Maintenance and Evolution / Enhancement Risk
    There are big changes coming in health care workflows to manage and track clinical and business operations across communities of care. It is not clear yet how this market is going to evolve and which vendors will likely lead. Open source products such as VistA allow system allow VA to avoid vendor lock-in, leverage community enhancements, and reduce the cost of product lifecycle management. A powerful global community has accelerated innovation in VA and the private sector through the Open Source Electronic Health Record Alliance (OSEHRA).

    By picking one vendor, VA would be making a bet with the associated risks by purchasing one vendor’s R&D and enhancement schedule. Propriety vendors will invest in whatever enhancements will make money in the commercial marketplace; they will not be exclusively focused on VA’s needs. However, the vendor will likely address many of VA’s requirements as part of any contract.

    Support for Health Care Delivery Transformation / Interoperability
    VA’s real challenge is to transform how care is delivered to Veterans – this goes well beyond rebuilding the electronic health record and focuses on expanding the capability of digital health services. Technology beyond the health record is needed to enable the transformation. VA’s DHP provides some of that vision. An open source commercial VistA could easily accommodate transformational changes such as using blockchain (a transformative technology) to secure, manage, and share health records). For example, the Hyperledger open source project provides blockchain code for community use. Interoperability with DoD and community providers will ideally be standards-based, which a commercial VistA will need to support.

    Interoperability with community providers has become a critical need for VA. The VA Community of Care will require VA IT systems to exchange health data with virtually every electronic health record (EHR) system in use today. Data integration remains an issue with all potential solutions, and the community care integration issue is not solved by any of the providers. Since this is a need across the health care space, proprietary vendors are working on these solutions. Some solutions may be proprietary and not work outside of the vendor’s and other specifically selected health record products. A vendor would be unlikely to incorporate well developed open source code into their software as the open source portion is available to the community. Vendors are working on transformative technologies, but what will be available to VA depends on which vendor is selected.

    Congressional frustration is real regarding a perceived slow pace of health IT progress at VA and that a course adjustment is needed. Despite the frustration, a full scope business case analysis considering all business case elements must be conducted to come to the best decision for VA and the government overall. A commercially supported VistA (VA employees not part of software development, maintenance, and VistA operations) provided as a service, has some advantages. VA should carefully consider all elements of the business case before making its electronic medical record decision.

    Ira S. Sachs is the President of I. S. Sachs and Associates, LLC. He can be reached at He has worked on a number of VA and VistA contracts throughout his career and is currently working on a VistA-related contract.

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    IDC predicted significant merger and acquisition activity on the electronic health record and revenue cycle management horizons, and soon.

    “Consolidation of the EHR market continued to dramatically separate the top 2-3 EHR firms from the rest of the EHR software firms,” Sven Lohse, research manager for Healthcare IT Services Strategies at IDC’s Health Insights unit, wrote in an email. “Epic, Cerner, eClinicalWorks, and athenahealth grew strongly, while competitors languished or shrank.”

    Epic, in fact, took the fifth slot on IDC’s HealthTech Rankings 2017 that the firm revealed on Monday.

    Epic is part of IDC’s Top 50, which encompasses companies that generate more than 33 percent of overall revenue from healthcare providers or payers. The others are Optum, Cerner, GE Healthcare and McKesson Technology Solutions, respectively. Allscripts crossed the finish line in sixth place, with athenahealth sliding into the seventh spot.

    [Also: Is a takeover of athenahealth inevitable?]
    While producing the rankings, IDC also compiled what Lohse called second order insights, notably that hospitals should act now to prepare for vendor consolidation among revenue cycle management vendors, top companies such as Optum, Cerner and Epic will expand clinically-oriented offerings with analytics for value-based care, and the EHR market maturation so many people in the industry are expecting is quickly approaching.

    “EHR market share is concentrating with vendors that have the scale and accelerating the rate at which we can expect smaller firms to be acquired or shrink,” Lohse wrote. “Rapid consolidation by M&A in this marketplace is imminent.”

    IDC also ranked the Enterprise Top 25 vendors, meaning they have a healthcare presence but collect less than 33 percent of revenue from providers and payers. The top five within IDC’s Enterprise 25 are IBM, Royal Philips, Siemens, Intel and Microsoft.

    The consultancy bases its HealthTech Rankings on total revenue for both calendar and fiscal years 2015 and 2016. 

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    President Trump’s budget proposal, released Tuesday, allocates $38 million to the Office of the National Coordinator for Health IT for 2018. That’s $22 million, or 37 percent, less than the $60 million ONC had in previous years.  

    In other words: ONC is now charged with doing almost everything it already was but with considerably less in the way of financial resources.

    The budget document, in fact, states that ONC’s two key priorities are health data interoperability and EHR usability. Trump’s document also instructs ONC to reduce support for the National Learning Consortium and the Consumer e-Health programs.

    “The FY 2018 Budget emphasizes ONC’s continued policy coordination work, utilizing ONC’s new Health IT Advisory Committee, as required by the 21st Century Cures Act,” the budget states. “ONC will also focus on thwarting information blocking and prioritize its work on standards coordination, implementation, testing, and pilots to accelerate industry progress toward interoperability.”

    The budget document also said ONC will work in conjunction with the Office of the Inspector General to penalize any organizations that are conducting data blocking practices.

    And ONC’s Health Information Technology Advisory Committee, newly-formed under the 21st Century Cures Act by merging the former Health IT Policy and Health IT Standards committees, is tasked with the work of convening public and private stakeholders to advance secure interoperability.

    “As a result of ONC’s shifting agency priorities and renewed focus on core health IT functions, ONC will reduce adoption support activities such as the National Learning Consortium and the Consumer e-Health program and focus efforts on statutorily required planning, evaluation, and monitoring of interoperability,” Trump’s budget said. “ONC also will continue to provide the latest information for patients, providers, and developers on its website,

    ONC responded to a request for comment by directing queries to the U.S. Department of Health and Human Services, which did not immediately reply.

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    On the EHR world stage, Intersystems and Epic won more new hospital contracts in 2016 than any of their rivals, according to a new KLAS report: “Global EMR Market Share 2017.”

    The two companies broke ahead of both their multiregional and regional competitors.

    “In addition to cost, many other factors were important in providers’ decisions,” said KLAS, which added that many EHR vendors recorded strong years.

    InterSystems’ strong 2016 sales across Europe, Asia and the Middle East included new contracts with several multi-hospital organizations in the U.K. and China.

    [Also: InterSystems to roll out TrakCare for NHS in Scotland]

    InterSystems appealed to buyers with their “all-in cost” that is lower than either Epic or Cerner, KLAS said.

    With new contracts across Canada, the Netherlands and Finland, Epic was the most popular higher-cost technology. Clients were drawn to Epic for its robust clinical functionality and strong usability, KLAS said.

    Hospitals in the UK, Australia, and the Middle East chose Epic rival Cerner in new and add-on contracts. However, fewer new hospitals contracted with higher-cost Cerner than in the past, KLAS said.

    Cerner is the most-used EHR by public hospitals in the Middle East, Klas said. The United Arab Emirates Ministry of Health expanded its Cerner footprint, even helping a separate hospital that had selected Epic to pivot and deploy Cerner. The system went live in time for the hospital’s opening.

    Cerner also expanded in Qatar and the UAE and for the first time into Kuwait. A small hospital group in the UAE selected InterSystems.

    The largest private hospital – about 400 beds – to make a decision in the region was the only organization to choose Epic.

    In Canada, two organizations – both in Ontario – that finalized a new vendor contract chose Epic. And three of the five Canadian organizations that have signed with new vendors since 2014 chose Epic, with the other two selecting Cerner.

    Also, while new vendor decisions are rare, six hospitals chose to migrate to MEDITECH’s new Web platform in 2016, continuing an ongoing trend in the region.

    Agfa HealthCare and ChipSoft staved off the potential encroachment of multiregional vendors by continuing to grow their leading market share footprints in Germany, Austria and Switzerland and the Netherlands.

    Meanwhile, Phillips signed a customer in Germany -- their first outside Latin America. KLAS did not validate any 2016 wins for several regional vendors covered in previous reports, including QuadraMed, ALERT, Cambio, and STG (System C).

    Epic is expanding in Nordics -- it’s first Danish hospitals went live in 2016. But in the Netherlands, organizations selected lower-cost ChipSoft more often than Epic.

    Also, hospitals in the Bahamas and Singapore selected Allscripts.

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    Beth Israel Deaconess Care Organization on July 1 will debut a platform for cloud-based real-time analytics with the goal of improving population health.

    The value-based network and accountable care organization will use analytics and electronic health record information aggregation systems from Arcadia Healthcare Solutions to integrate into real-time clinical and claims data to enhance quality and efficiency and trim costs.

    “Reimbursement is evolving from fee-for-service to value-based purchasing,” said John Halamka, MD, CIO of Beth Israel Deaconess System. “Existing IT tools are not optimized for managing wellness, they’re designed for documenting sickness. Our work at Beth Israel Deaconess Medical Center is focused on adding analytics technologies on top of existing EHR platforms that help us enroll groups of patients in care management programs then monitor their daily progress so we can discover gaps in care and intervene whenever anything changes – laboratory values, symptoms, mood, activities or home telemetry.”

    [Also: Beth Israel Deaconess pilots Everseat scheduling app]

    Further, the provider organization combines clinical and financial data in its analytic repositories, enabling it to examine variations in cost and outcome and provide benchmark comparisons for all of the health system’s institutions and clinicians, Halamka added.

    Beth Israel Deaconess Care Organization includes nine hospitals and 2,600 physicians. To become a member of BIDCO, an organization must have a BIDCO-approved EHR, which include athenaClinicals, Centricity, eClinicalWorks, Epic, NextGen and WebOMR, which is a BIDCO-built EHR.

    [Also: See the 832 hospitals that earned an 'A' in patient safety]

    All of these EHRs transmit clinical data to BIDCO’s data repository, which then transmits the information to a population health data repository. Clinical and claims data is merged there. Arcadia will add scheduling and admission/discharge/transfer data into the mix

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    Interoperability doesn't just mean ensuring easy data exchange between two EHR systems anymore, Karen DeSalvo, MD, said on Tuesday. Patients have have an essential role to play, too.

    DeSalvo, former assistant secretary for health and national coordinator for health IT, spoke at the Bipartisan Policy Center in a panel discussion with Andrew von Eschenbach, MD, former Commissioner of the U.S. Food and Drug Administration.

    The discussion, moderated by former U.S. Senate Majority Leader Bill Frist, MD, was about "Patient Safety and Information Technology," and it aimed to explore ways IT can still do better at enabling improvements to help prevent medical errors, which still cause the deaths of more than 200,000 Americans each year.

    [Also: Patient matching strategy gains ground with support from Congress]

    There are myriad ways health IT can help prevent adverse events, DeSalvo said, whether it's the ability to check for drug interactions in an automated fashion rather than having to thumb through a hefty formulary with very thin pages, or advanced clinical decision support, which has shown that it can improve the safety of care.

    We've come a long way since 2009, where the passage of the HITECH Act and subsequent federal investment of $36 billion laid the groundwork for a nationwide health information technology infrastructure, she said.

    "The iPhone was barely on the market back then," said DeSalvo. "We were barely thinking of IT in the way we do today."

    Flash forward eight years, and 90 percent of providers are up and running on EHRs.

    “Many people have multiple electronic health records," said DeSalvo. "We have a nice opportunity to leverage that data and make it more actionable."

    Culture change required for interoperability

    But for all the progress the past decade, "IT is still in an adolescent phase," she said. It can be clunky and there are challenges with usability, too. “There's a lot of hunting and pecking still going on," said DeSalvo, and plenty of work to do simplifying systems to reduce the signal-to-noise ratio for overburdened clinicians.

    And interoperability, of course, remains a challenge.

    "We're increasingly using shared standards, but not quite there," said DeSalvo. The flow of data is complicated too by "another suite of technologies that are unregulated because they're about lifestyle and management," and sometimes by providers' misunderstanding of HIPAA, "which is meant to guide sharing, not prevent it," she said.

    One essential challenge to more widespread interoperability is cultural, said von Eschenbach. Physicians of his generation "grew up in a culture that was highly egocentric and individualistic.

    "I was brought up to play golf, he said. "Today the game is basketball. We have to come together and work together in a more collaborative and interoperable way."

    DeSalvo agreed that quality improvement and value-based care depend on that collaboration. 

    "I don't think you can get there without a team-based culture," she said. "I still believe that moving to value-based payment is a driver to get more doctors to think about cooperation. Better data does change culture and behavior."

    But one key factor to changing attitudes about interoperability is often underappreciated, said DeSalvo: The role of the patient.

    More widespread use of APIs has opened up opportunities for a lot of innovation, particularly with regard to consumer-mediated exchange, she said.

    Giving patients more control over their health data "creates a completely different window to their health world," said DeSalvo. "It doesn't have to be two systems talking to each other."

    Increasingly, she sees data flowing toward places where consumers control, manage and share their data, enabled by trusted third parties and digital vaults.

    "People have a willingness to free that data, so it can be put to good use," said DeSalvo. "We are a team, and part of that team is the consumer."

    The model of healthcare is fast-evolving to make this more and more prevalent, as patients have more skin in the game with higher out-of-pocket costs, she said. They'll have more agency to choose their providers based on the services they can provide, and "more and more they're going to want to have access to their information."

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    Healthcare industry associations reacted to the White House’s budget proposal that circulated on Tuesday with strong cautionary tones and a call on Congress to fund the Office of the National Coordinator for Health IT adequately.

    “This budget request stops progress in its tracks,” Thomas Payne, MD, board chair of the American Medical Informatics Association, said in a statement.  “The ecosystem that entices young scientists and clinicians to pursue their passion to help patients will be severely damaged, resulting in a downward spiral of innovation, delayed or forgone investment in new treatments, and a stagnant patchwork of IT-enabled patient care.”

    [Also: Trump's budget slashes ONC by more than a third]
    President Trump’s proposed budget slashes $22 million from ONC, $5.6 billion from the National Institutes of Health, $100 million from the National Center for Advancing Translational Sciences, $21 million from the National Library of Medicine, and effectively eliminates the Agency for Healthcare Research and Quality.

    “We are disappointed by the Administration’s proposed cuts to ONC,” AHIMA CEO Lynne Thomas Gordon said. “The bipartisan passage of the Cures Act by Congress last year made clear that investment in our nation’s health IT infrastructure is critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system. ONC is a critical partner in this endeavor.”

    [Also: Trump budget cuts $600 billion from Medicaid]
    The Healthcare Information and Management Systems Society also expressed concern that Trump’s budget proposal would have a negative impact on innovation, care quality and patient safety and sends the wrong message about the U.S. as a medical innovation leader.

    “The cuts to ONC will delay advancements in interoperability and information sharing outlined in the 21st Century Cures Act,” HIMSS said. “Cuts to CDC will delay advancements in national priorities like the public health preparedness infrastructure, while defunding AHRQ will all but eliminate discovery of best practices that will improve care delivery and increase value for patients, and reduce costs for the federal government.”

    Trump’s budget proposal still has to make it through Congress, of course, which many political experts are already saying will prove challenging. HIMSS and AHIMA urged Congress to reject the budget reductions with Trump’s proposal.

    “We hope that as congressional appropriators draft the Labor, Health and Human Services, Education and Related Agencies appropriations bills for fiscal year 2018, they will ensure that ONC is properly funded and signal their commitment to meeting the goals of the 21st Century Cures Act,” AHIMA’s Gordon said. 

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