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    Apple is said to be working with the Argonaut Project to integrate more electronic health data with the iPhone, a move experts say could go a long way towards advancing medical record interoperability.

    Participants in the Argonaut Project – an HL7-led initiative focused on expanding the use of open standards for health data exchange, notably HL7's FHIR specification – are some of the industry’s most notable vendors and providers: Accenture, athenahealth, Cerner, Epic, McKesson, Meditech, Surescripts, The Advisory Board Company, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Intermountain Healthcare, Mayo Clinic, Partners HealthCare.

    [Also: Timeline: How Apple is piecing together its secret healthcare plan]

    It's not a bad place, then, for Apple to get some ideas about better integrating its products into a complex and fragmented healthcare ecosystem.

    Argonaut leader Micky Tripathi, president and CEO of Massachusetts eHealth Collaborative, would not comment on anything specific about Apple's discussions with the group, but he was glad to offer some thoughts on what iPhone-based health records could potentially mean for healthcare more generally.

    In particular, Tripathi seemed excited that Apple could play a significant role in improving interoperability – especially with regard to consumer-mediated exchange.

    "There has been more and more effort and attention being paid to empowering patients with the ability to aggregate their own data, and then do more with it than they otherwise would have," he said. "That's the idea, and the hope people have. There are many challenges to that, but we're making incremental progress on the way."

    Tripathi said he could envision a world where a patient is able to aggregate all of their records on their device, and "use that as the vehicle for sharing."

    For instance, a diabetic could use an iPhone-based diabetes app and populate it with his or her own health data. "They could say, 'Alright, app, go to the API at Beth Israel Deaconess Medical Center and get my diabetes-relevant information.' Maybe that's lab results related to diabetes, but it's not everything – those records could be voluminous, but the app is able to go out and get just that information that's important to me."

    The big challenge, at the moment, is that healthcare is still largely lacking when it comes to a "trust ecosystem," said Tripathi. But that's another area where Apple, with is nearly unparalleled familiarity, could offer an answer.

    Opportunities for trusted exchange

    In addition to to pushing for broader use of the FHIR standard, the Argonaut Project also champions the OAuth 2.0, an open profile for authorizing apps to access FHIR data.

    "If I have a trusted relationship with an organization and they offer me credentials, OAuth is really good, from a technical perspective, at my being able to go to another organization, and, rather than having to have separate username, password, whatever credentials I need for that organization – if that other organization trusts the original organization who made the credentials, then they can just make an OAuth call back and say, 'Someone is presenting themselves as Micky Tripathi. Do you have a Micky Tripathi?' If the response is yes, they pass a technical security token and that enables me to be able to access that third-party thing."

    It's an exciting technical concept: A patient has an app and can go to five different hospitals to get their data. The challenge, though, is that there's a sprawling healthcare ecosystem right now with no obvious answer to who could play that trusted role.

    "Health insurers? Maybe. The problem with insurers is that they're really fragmented, they're all over the country, and people jump around from insurer to insurer," said Tripathi.

    "Or could large providers play that role for each other? In Boston, Mass General may be willing to trust Beth Israel, and vice versa. But they're local organizations. And you have this n-squared problem: Does every pair have to trust each other in that way? Or does everyone trust Mass General, and is that weird because they're a competitor?"

    Apple, on the other hand, could potentially offer that trust. "One could imagine Apple playing a role that very few other organizations can play," said Tripathi.

    "Hospital A, Hospital B, Hospital C, rather than issue their own credentials, would be willing to say, 'Oh, if Apple trusts them, that's fine. We'll let the app in to do what it's going to do,'" he said. "That's one area, where I think it could lay a firm foundation for a consumer-driven ecosystem that would help with consumer enablement of being able to get their healthcare."

    Beyond patient engagement

    The concept of consumer-mediated exchange is just as intriguing. 

    "What if you were able to aggregate your records on your iPhone, and essentially solve the interoperability problem yourself?" said Tripathi.

    The most "clunky" and basic way to do that, is to simply say, "Here doc, here's my iPhone, take a look at my record," he said.

    "But perhaps a more mature approach could possibly be that you would have provider organizations subscribing to an Apple service, say, where they subscribe and, as an Apple patient, I have all my records there. They could go down a list – Beth Israel Deaconess, check; Harvard Vanguard, check – and access my data that way, almost like a health record bank."

    The notion of a health record bank has been around for about 10 years, but hasn't gained much traction, thanks again to issues of fragmentation and trust. "No one organization is prominent enough nationally to be able to have everyone across the country say, 'Yes, sure, I could imagine trusting them,'" said Tripathi. "Obviously, Apple has that kind of visibility and that kind of place in consumer consciousness."

    Apple could also ease many clinicians when it comes to patient-mediated data, he said.

    "Providers have a degree of mistrust of information that has been handled by the patient. Not because they don't trust them, but you just don't know what happened in that circumstance. Did it get garbled, is some stuff being left out because they don't want me to know something?

    "Apple certainly has the technical smarts to be able to establish data provenance with those records, so if I got the record through some Apple service, through various existing security and non-repudiation kinds of mechanisms that exist today, I would be able to know that this record hasn't been screwed around with since it came from Beth Israel. It just happened to be in the patient's control, they haven't changed anything."

    For his part, Tripathi feels that there's been something of a sea change with public perception: how they see their data, and how they see their smartphones.

    "If you had asked five years ago, there would have been a different sense to this. It just feels to me, intuitively and anecdotally, like we've had some sort of a change in the way we think about privacy, and protection of privacy," he said

    Earned or not, Tripathi thinks people have a much higher degree of comfort in trusting their data with companies such as Apple.

    "People have much more of a sense of their phone being an extension of themselves,” he said. “Your phone is much more a part of you and a reflection of you, and something you trust it to have personal information – sometimes deeply personal information.”

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


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    Sens. John McCain, R-Arizona, Johnny Isakson, R-Georgia, and Jerry Moran, R-Kansas, are calling on the U.S. Department of Veterans Affairs and the Department of Defense to prepare a timeline for the Cerner installation, in a letter released Thursday.

    VA Secretary David Shulkin, MD, recently made the announcement that the VA would transition its outdated VistA electronic health record to Cerner to match the DoD. The senators want to know the steps both agencies will take to ensure the platforms are interoperable.

    Given that recent federal IT infrastructure overhauls haven’t been wholly successful, the senators expressed concern about the risks related to costs and implementation delays.

    [Also: House committee earmarks $65 million for VA's Cerner EHR transition, but there's a catch]

    Specifically, the senators want an outline of the phasing plan, projected timeline and major completion milestones. Further, they want the DoD to share best practices, which can, in turn, be used by the VA. They also want to know how the VA will start the EHR initiative.

    The senators are also looking for assurances that data sharing will be seamless. They want details on potential policy and technical barriers to implementation, including the needed changes in businesses practices to avoid “excessive customization” of the Cerner EHR.

    “We implore the VA to work with DoD’s experts to adopt any lessons learned and best practices from DoD’s recent experience with Military Health System Genesis implementation,” the senators wrote. “We can’t afford any mistakes on this project, as it has immense implications for the future of the VA and proper care of veterans.”

    The agencies attempted to work together on interoperability in the past, between 2009 and 2013. After spending nearly $1 billion, the agencies decided to work separately on the platforms. VA pushed for DoD to switch to VistA, but the agency instead chose Cerner.

    The Joint Legacy Viewer was created as a compromised, which allows providers from both agencies to view patient records. However, the records are unable to be completely integrated.

    Current estimates say the VA’s Cerner install won’t be completed for about 10 years. The DoD’s Cerner project is scheduled to be completed in 2022. While Cerner’s rollout cost $4.3 billion, Shulkin has yet to make a definitive estimate on the potential cost of the EHR implementation.
     

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


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    One of the frustrating challenges in putting precision medicine to work more widely for clinical care is integrating complex and voluminous genomic data into the EHR.

    Instead, in most cases, "we use a very highly interoperable standard for such material called 'PDF,'" joked Beth Israel Deaconess Medical Center CIO John Halamka, MD, when he spoke at the Healthcare IT News Precision Medicine Summit in Boston earlier this month.

    That's not necessarily a drawback. 

    "PDF is not so bad for visualization of data," said Olivier Elemento, associate director of the Institute for Computational Biomedicine at Weill Cornell Medicine in New York. "Clinicians can see the data in a way that's nice-looking and easy to understand," 

    [Also: Precision medicine demands ‘evolutionary leaps of interoperability’]

    But at Weill Cornell, clinicians are able to access genomic information as structured data in the EHR. Staff at the academic medical center have found success integrating actionable test data into the Epic system to enable clinical decision support.

    In addition, the hospital has developed "entire app ecosystem" to help manage the workflow of genomic testing data, said Elemento, positioning it well to capitalize on the vast promise of precision medicine.

    "I hear a lot about the challenge people encounter, and the process of trying to integrate data into the EHRs and using them in clinical workflow," said Elemento. "At least here at Cornell, it seems like we've taken on the challenges and made some pretty good progress."

    That's not to say that the successes have been effortless. "We've experienced some things that don't work – but also thankfully have experienced some things that work."

    At Cornell's Caryl and Israel Englander Institute for Precision Medicine, Elemento has spent the past four years focused on integrating complex data into Epic in a structured form that makes genomics more clinically relevant, he said.

    One of its programs focuses on advanced metastatic cancers, looking for actionable genetic mutations that could respond well to immunotherapy or innovative drugs.

    Using a whole-exome sequencing test, clinicians "evaluate the mutational profile of these patients," said Elemento.

    "The test is pretty extensive," he added. "It covers 21,000 genes and is used routinely now for advanced cancer patients now at Cornell and NewYork-Presbyterian."

    That "extensive mutational modeling of tumors" leads to a report that is eventually attached to the EHR as a PDF – a data-rich and easy-to-read document that can be consulted by physicians.

    But Weill Cornell has also found a method to push that same information into Epic as structured data, said Elemento. "We figured out a way to craft HL7 messages so these messages are accepted in Epic and displayed as tables: you can see mutations, interpretations of mutations."

    One key, he said, is to be selective in the specific data that's displayed.

    The PDF report contains every mutation discovered by the clinicians, but they're ranked, so to speak. The most important mutations, the actionable ones, are at the top of the report, he said. "In the middle of the report you have other mutations driving the cancer, and then we also put the passenger mutations.

    While the report itself displays all those mutations, "it turns out that displaying it all as structured data in Epic is not possible," said Elemento. "We tried it and it didn't work. Epic is not designed to handle the large number of mutations which you could find in a typical patient, many of which actually are not actionable.

    "So what we did was push all of these mutations into Epic as structured data, but we only display the actionable data," he said. "All the data is in there. And we can do the data warehousing and analytics. We can do queries based on genomic data for every mutation that's in the EHR – in addition to combining other data for the patient – clinical data, demographics, conditions, diagnosis, meds, prescriptions and so on.

    "We push everything into Epic as structured data, but we only display what's most important and relevant for patient care," he added. "But everything is still available as queries. That helps when it comes to things like populating clinical trials."

    A Cambridge, Massachusetts-based company called Standard Molecular, which specializes in HL7 and XML integration of discrete data, helped out on the initiative. Its Chief Medical Officer, David Artz, MD, is an associate professor at Weill Cornell and former CMIO at Memorial Sloan Kettering Cancer Center. Before that, he worked at Chicago's Northwestern Memorial Hospital, where he implemented both Cerner and Epic systems.

    "David Artz has a lot of experience with Epic, so they've essentially been able to help us connect our workflows with Epic," said Elemento. "Part of it is basically translation – putting it into a format Epic can accept. Essentially all of it is just crafting HL7 messages: The data pushed into Epic as HL7 messages and then can be consumed there."

    "Integrating rich discretely detailed genomics data into medical records was a longstanding technical challenge, which we have now solved,” said Artz in 2016 when the Englander Institute for Precision Medicine first announced its success adding computer-readable genomic data to its EHR. The next step, he said, was to share the advancement with other hospitals.

    "This project could advance the field of precision medicine beyond Weill Cornell," said Artz.  "We’ve created a model for how it could be used elsewhere, especially at other institutions that use Epic."

    Beyond its EHR success story, Weill Cornell has also built out its IT infrastructure to make more effective and efficient use of genomic data – an "app ecosystem allows us not only to track samples across the entire process but also essentially be able to do things like ordering tests, ordering for Epic, tracking samples across the workflow," said Elemento.

    "Clinical genomics is a complex activity: It involves multiple groups, multiple people, and if you look at the lifecycle of a sample as it goes from biopsy to sequencing to reporting to going into the EHR, there are many many steps. To really facilitate this, IT plays a major role.

    In sequencing thousands and thousands of samples, "we need to be able to have essentially real-time tracking," he said. "You want to know where the sample is at in the process. All this stuff is being tracked through apps that allow us to understand all aspects of the process."

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


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    Hospitals have been making big investments in interactive patient systems, finding that they're more useful than mere televisions thanks to the education and entertainment they offer patients.

    A new report from KLAS finds that they're are looking for more advanced functionality and connectivity, seeking greater returns and improved patient outcomes.

    Generally speaking, products from TVR Communications outperform those from other IPS vendors "in all areas of sales, support, and technology," according to report, which noted that GetWellNetwork and SONIFI Health also scored well for their deeper functionalities.

    [Also: Are EHRs getting better? Readers rank vendors higher than last year in new survey]

    The hospitals using Epic for their IPS were satisfied, according to KLAS, but it's a small sample of respondents. Cerner too has a "limited" client base of early adopters who tended to report that the product development is "incomplete," according to the report, which noted that Cerner is the only vendor with a performance score below 80.

    While it's fairly common in other areas of IT for hospitals to abandon best-in-breed systems in favor of products developed by their electronic health record vendor, that so far hasn't been the case with ISP, said KLAS researchers.  

    "Cerner EMR customers say integration gives CareAware MyStation some cost advantages, but nearly two-thirds say the product’s maturity and functionality do not yet justify migrating,"  they said. "About two-thirds of Epic EMR customers say they are planning or considering a MyChart Bedside implementation. The product’s EMR integration successfully delivers patient-portal-like capabilities to hospital patient rooms. Some say MyChart Bedside is unlikely to displace their current IPS solution because it lacks key IPS functionality, including entertainment options."

    Whichever vendor they use, most hospitals are still looking for more from their IPS tools, beyond entertainment and education. They're looking for real-time communication capabilities, better reporting analytics and – perhaps ironically, given Cerner's and Epic's limited market share – better integration with their EHR systems.

    Providers most often say that suboptimal EHR integration "is the single largest barrier to achieving more meaningful outcomes," according to KLAS.

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


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    Two North Carolina-based rival healthcare systems, Novant Health and Carolinas HealthCare, will start exchanging patient records electronically, they announced June 28.

    Novant is an Epic IT shop, while Carolinas HealthCare uses Cerner technology.

    The goal for records exchange: To improve the quality and coordination of care for patients who use both systems by allowing doctors and clinicians to access portions of electronic medical records, the organizations said.

    Charlotte-based Carolinas HealthCare and Winston-Salem-based Novant have about 9 million patient records between them. They have agreed to exchange demographics, test results, diagnoses and visit summaries.

    “What used to take days or weeks to receive patient information from another health system will now be near instantaneous,” Craig Richardville, chief information and analytics officer for Carolinas HealthCare, said in a statement.

    Carolinas HealthCare System and Novant Health have chosen to build connectivity through their respective Health Information Exchange systems.

    The health systems called the move a “significant step” toward reducing re-admissions and duplicated tests and procedures. The measure, they noted, also lowers costs.

    “Our partnership is transforming care for our patients and our providers by securely exchanging patients’ medical information among providers in and outside of our healthcare system, AJ Patefield, MD, Novant Health chief medical information officer, said in a statement. "Our goal is to ensure our providers have the most up-to-date information and give them the opportunity to spend more meaningful time with their patient versus tracking down test results or clinical data."

    Novant Health and Carolinas HealthCare System are also working in partnership to address healthcare disparities.

    Carolinas HealthCare, is North Carolinas largest hospital system, with more than 40 hospitals. The Novant network includes 14 hospitals.

    When Healthcare IT News interviewed Richardville at his office back in April, he noted that a lot of markets have two major players like Novant and Carolinas HealthCare. He characterized the relationship as “classic co-opetition.”

    “So, we do things together for the benefit of our patients,” he said. “There is no competition in how we want to take care of and benefit the community that we all live in and serve in.”

    “It is your data as a patient,” he added. “When you go to Point B, we want that provider to have all the information that’s relevant to take care of you.”

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


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    Author: 
    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%20slideshow.png
    Slideshow Description: 

    Healthcare proved itself a lucrative target for hackers in 2016, and so far 2017 is, unfortunately, following suit. From organizations with exposed, unused websites to unencrypted storage drives, health organizations appear to still have much to learn about security.

    This gallery highlights some of the biggest breaches across the industry – and points to some mistakes to avoid in the future.

    Updated June 30, 2017

    Slideshow Image: 
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    Slideshow Title: 
    Cleveland Medical Associates
    Slideshow Description: 

    While the compromised computer was both locked and encrypted, the forensic investigation team couldn’t determine with certainty if there was unauthorized access to patient data during the April 21 attack.

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITNDataBreach500k.png
    Slideshow Title: 
    Airway Oxygen
    Slideshow Description: 

    Michigan-based Airway Oxygen was hit by a ransomware attack in April that may have compromised the data of 500,000 clients, the home medical equipment supplier reported to the U.S. Department of Health and Human Services on June 23. The hacker gained access to the network and installed ransomware, which shut employees out of the system where personal health information was stored.

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITNDataBreach-6K.png
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    Data has been dumped from two healthcare providers in a game the hacker, TheDarkOverlord, is calling: “A Business a Day.” The hacker leaked 6,000 patient records on June 8 from Feinstein & Roe MDs in Los Angeles and 6,300 patient records from La Quinta Center for Cosmetic Dentistry on June 9.

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITNDataBreach-1M.png
    Slideshow Description: 

    A hard drive containing the personal data of about 1 million people was stolen from Washington State University in April. The University discovered a locked safe that contained the hard drive was stolen from a WSU storage unit in Olympia. The stolen data is from survey participants and contained names, Social Security numbers and, for some, personal health data.

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITNDataBreach-undisclosed.png
    Slideshow Description: 

    California-based Torrance Memorial Medical Center notified patients that two email accounts containing work-related reports were hit by a phishing attack in April. Officials didn’t reveal how many patients were affected, and the incident is not on the Office of Civil Rights’ breach reporting site.

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%204-8million.png
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    Molina Healthcare
    Slideshow Description: 

    Molina Healthcare, a major Medicaid and Affordable Care Act insurer, shut down its patient portal on May 26 in response to a security flaw that exposed patient medical claims data without requiring authentication, according to security researche Ben Krebs. At the time, it’s unclear how long the vulnerability was in place. Ben Krebs was first made aware of the security flaw in April through an anonymous tip, which could allow any Molina patient to access other patients’ medical claims by simply changing a single number in the URL.

    Read the full article.

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    National Health Service in England and Scotland
    Slideshow Description: 

    The National Health Service in England and Scotland was hit by a large ransomware attack that has affected at least 16 of its organizations on May 12. The organization launched an investigation and determined the ransomware is likely the Wanna Decrytor. It’s one of the most effective ransomware variants on the dark web, and at the moment, there is no decryptor available. Within two days, 150 countries were affected by the #wannacry ransomware.

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2014633k.png
    Slideshow Title: 
    New Jersey Diamond Institute
    Slideshow Description: 

    The third-party server that hosts the electronic health records of New Jersey Diamond Institute for Fertility and Menopause was hacked by an unauthorized individual, exposing protected health information of 14,633 patients.

    The database and EHR system was encrypted, which prevented the hackers from gaining access, officials said. However, many supporting documents stored on the hacked server were left unencrypted and could have been accessed.

    Read the full article

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    Slideshow Title: 
    Harrisburg Gastroenterology
    Slideshow Description: 

    Pennsylvania-based Harrisburg Gastroenterology is notifying patients that their records might have been breached. The Health and Human Services Department’s Office for Civil Rights’ Wall of Shame lists the breach at 93,323 records on a network server exposed because of a hacking/IT incident.

    Read the full article

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    Slideshow Title: 
    Bronx-Lebanon Hospital Center
    Slideshow Description: 

    Tens of thousands, and possibly up to millions, of patient records at Bronx-Lebanon Hospital Center in New York City were exposed in a recent data breach, according to the Kromtech Security Research Center, which uncovered the records on May 3. The records were part of a backup managed by iHealth Innovations, the research center said.

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%20180k.png
    Slideshow Title: 
    Aesthetic Dentistry and OC Gastrocare
    Slideshow Description: 

    Dark Web hacker TheDarkOverlord has released 180,000 patient records from three hacks, DataBreaches.net revealed May 4. More than 3,400 patient records were released from New York City-based Aesthetic Dentistry, 34,100 from California’s OC Gastocare and 142,000 Tampa Bay Surgery Center. TDO used a Twitter account to post a link to a site that allows any user to download the patient databases from these organizations.

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%20500k.png
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    Children health records
    Slideshow Description: 

    The patient records of about 500,000 children are up for grabs on the dark web, a hacker named Skyscraper told DataBreaches.net on April 26. These records contain both child and parent names, Social Security numbers, phone numbers and addresses. DataBreaches didn’t name the breached organizations but also said that another 200,000 records were stolen from elementary schools. The amount of breached records for pediatricians reported to the Department of Health and Human Services’ Office of Civil Rights is not equal to that number, meaning many of these providers are likely unaware their data has been exposed.

    Read the full article

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    Slideshow Title: 
    Lifespan
    Slideshow Description: 

    Providence-based Lifespan, Rhode Island's largest health network, has notified about 20,000 of its patients that a laptop theft may have exposed their sensitive information. The health organization said an employee's MacBook was taken after a car break-in on Feb. 25. The employee immediately contacted both law enforcement and Lifespan officials, who were able to change the employee’s credentials used to access Lifespan system resources.

    Read the full article

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    Slideshow Title: 
    HealthNow Networks
    Slideshow Description: 

    The personal health data of 918,000 seniors was posted online for months, after a software developer working for HealthNow Networks uploaded a backup database to the internet, an investigation by ZDNet and DataBreaches.net found. Boca Raton, Florida-based HealthNow Networks is a telemarketing company that used to provide medical supplies to mostly seniors who rely on diabetic equipment. However, it’s no longer a registered business as of 2015, when it failed to file an annual report with Florida authorities. The software developer was contracted to build a customer database for HealthNow Networks, but the developer told researchers it was "too much work."

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2055k.png
    Slideshow Title: 
    ABCD Children's Pediatrics
    Slideshow Description: 

    A ransomware attack at San Antonio-based ABCD Children’s Pediatrics may have breached the data of 55,447 patients. Affected files may have included patient names, Social Security numbers, insurance billing information, dates of birth, medical records, laboratory results, procedure technology codes, demographic data, address and telephone numbers. Investigators determined it was the Dharma virus, a variant of the Crisis ransomware family. While this virus doesn’t typically exfiltrate data, the provider was unable to rule it out, officials said.

    Read the full article

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    Washington University School of Medicine
    Slideshow Description: 

    A Washington University School of Medicine employee fell victim to a phishing attack that may have compromised 80,270 patient records. The medical school learned of the incident on Jan. 24 -- seven weeks after the phishing attack occurred on Dec. 2, officials said in a statement. The employee responded to a phishing email designed to look like a legitimate request. As a result, an unauthorized party may have gained access to employee email accounts that contained patient data.

    Read the full article.

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    Slideshow Title: 
    Metropolitan Urology Group
    Slideshow Description: 

    This Milwaukee-based provider began notifying patients that a November ransomware attack may have exposed their personal data. There were 17,634 patients affected, according to the U.S. Department of Health and Human Services' Office for Civil Rights. Two of Metropolitan Urology’s servers were infected by the virus, which may have exposed data of patients between 2003 and 2010. Officials said the data contained names, patient account numbers, provider identification, medical procedure codes and data of the provided services. About 5 percent of these patients had their Social Security numbers exposed.

    Read the full article.

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%20years%20vuln.png
    Slideshow Title: 
    Denton Heart Group
    Slideshow Description: 

    An unencrypted hard drive that contained seven years of backup electronic health record data was stolen from the Denton Health Group, a member of the HealthTexas Provider Network. The backup files contained a hoard of patient data from 2009 until 2016: Names, Social Security numbers, dates of birth, addresses, phone numbers, driver's license numbers, medical record numbers, insurance provider and policy details, physician names, clinic account numbers, medical history, medications, lab results and other clinical data.

    Read the full article.

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    Slideshow Title: 
    Brand New Day
    Slideshow Description: 

    In March, the Medicare-approved health plan notified 14,005 patients of a potential breach of electronic protected health information after an unauthorized access through a third-party vendor system. On Dec. 28, Brand New Day discovered that an unauthorized user had accessed the ePHI provided to one of its HIPAA business associates on Dec. 22. The access occurred through a vendor system used by a contracted provider, officials said.

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    Singh and Arora Oncology Hematology
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    In February, the Flint, Michigan, cancer center notified 22,000 patients of a breach discovered in August 2016. Hackers had access to the practice's server between February and July of 2016, local affiliate ABC12 reported. The files contained names, Social Security numbers, addresses, phone numbers, dates of birth, CPT codes and insurance information.

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    Verity Medical Foundation-San Jose Medical Group
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    Verity Medical Foundation-San Jose Medical Group website, part of the Verity Health System in Redwood City, California, was hacked, exposing the data of 10,164 patients. Verity includes six California hospitals, the Verity Medical Foundation and Verity Physician Network. An unauthorized user hacked into the website from October 2015 until it was discovered by Verity Health on January 6. The website was no longer in use.

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    CoPilot Provider Support Services
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    More than a year after discovering a potential breach to its websites, healthcare administrative services and IT provider, CoPilot Provider Support Services notified 220,000 patients and doctors who used its service. An unauthorized user breached one of CoPilot's databases, used by both healthcare providers and patients, in October 2015, according to officials. The hacker downloaded files that contained names, dates of birth, addresses, phone numbers, health insurers and some Social Security numbers of some users. No financial, medical treatment or other information was accessed.

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    Indiana-based Cancer Services
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    The server and back-up drive of Muncie, Indiana-based Cancer Services of East Central Indiana-Little Red Door were hacked and the data stripped, encrypted and taken for ransom by the cybercriminal organization, TheDarkOverlord, or TDO, the agency revealed Jan. 18. The hack took place on Jan. 11. TDO asked for 50 bitcoin, or about $43,000, in ransom, first in a text message to the personal cellphones of the company’s executive director, president and vice president. Officials said, TDO followed up in a form letter and several emails that contained extortion threats and promises to contact family members of the cancer patients, donors and community partners.

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    Emory Healthcare
    Slideshow Description: 

    Atlanta-based Emory Healthcare was hacked by the Harak1r1 the 0.2 Bitcoin Ransomware, MacKeeper security researcher Chris Vickery discovered on Jan. 3. On Dec. 30, MacKeeper Security Research Center discovered a misconfigured MongoDB database that contained data from over 200,000 patients and other sensitive information. On Jan. 3, the firm confirmed this data was linked to Emory Brain Health Center. It appeared Harak1r1 wiped a database of the Brain Health Center and blocked access to these records, Vickery said.

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    Healthcare proved itself a lucrative target for hackers in 2016, and so far 2017 is unfortunately following suit. This gallery highlights some of the biggest breaches in healthcare -- and points to mistakes to avoid in the future.

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    Allina Health announced this week that approximately half a million patients in the Minneapolis region can now read the notes physicians write about them.

    Allina said that its patients can now log into a portal to view not just those notes but also doctor’s instructions and next steps as well as prescriptions and orders. They will also be able to send messages to their care teams and participate in eVisits from computers, tablets or phones.

    In deploying the OpenNotes software, Allina joins the likes of Beth Israel Deaconess Medical Center, the U.S. Department of Veterans Affairs, Geisinger Health System and others in giving patients access to doctor’s notes. 

    The 12-hospital system with more than 90 clinics previously granted its consumers access to portions of their medical record, such as medication history and lab results and enabled them to schedule appointments online.

    Tim Sielaff, MD, senior vice president of Allina Health, described physician notes as the thread that ties an entire patient record together.

    “We know patients generally retain only a portion of the information that is exchanged with their doctor during an office visit,” Sielaff said in a statement. “Sharing these notes can greatly change the way patients engage with their doctor and manage their care.”

    OpenNotes co-director Tom Delbanco, MD has long contended that the effort is not just a software product but a movement and the initiative won the Data Liberator Award in April at Health Datapalooza.  

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    U.S. Representatives last week introduced bipartisan legislation to ease the burden that the meaningful use EHR incentive program puts on healthcare providers.

    The bill, H.R 3120, introduced Friday by Texas Republican Rep. Michael Burgess, MD, is short on paper but sweeping in its intent. Simply put: The proposed legislation strikes sentences from the HITECH Act requiring the HHS Secretary, now Tom Price, MD, to make meaningful use measures increasingly stringent.

    “Electronic health records have failed to live up to their promise to improve healthcare delivery for patients. Unfortunately, current law places an arbitrary requirement on the Secretary of Health and Human Services to impose an increasingly stringent burden on physicians’ use of these records systems,” Texas Republican Rep. Michael Burgess, MD, said in a statement. “This bipartisan legislation provides a common-sense solution for a burden that negatively impacts both patients and providers, resulting in better care.” 

    Rep. Debbie Dingell, D-Michigan, added that the legislation will enable HHS to advance the use of EHRs to both save clinicians time and improve the accuracy of delivering care.

    Ohio Republican Rep. Patrick Tiberi, meanwhile, said that easing the burden on providers and streamlining reporting processes under meaningful use will enable doctors to spend more time caring for patients.

    “This is an important part in our efforts to transition to a better patient-centered healthcare system,” Tiberi said.

    In addition to Burgess, Dingell and Tiberi, California Democrat Rep. Mike Thompson signed the proposed bill. 

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    Verona, Wisconsin-based Epic Systems apparently passed on bidding for work in its own backyard, giving its main rival a $33 million contract for the digital health information system planned by the Wisconsin Department of Health Services.

    EHR giant Cerner, with headquarters in Kansas City, Missouri, landed the contract for the 10-year project. Cerner’s was one of five bids for the work, which did not include a bid from Epic, according to Madison.com.

    “Epic chose not to participate in the Wisconsin Department of Health Services selection process given the smaller size and scope of this particular project," Epic spokeswoman Meghan Roh said in a statement. "Over 90 percent of Wisconsinites have a record in Epic and we look forward to our continued partnership with health systems across the Badger State.” 

    Cerner is also working on developing the Veterans Affairs EHR – a project it was awarded without competitive bid, having earlier won the contract for the Department of Defense EHR. 

    While Epic bid on the DoD modernization deal it did not have the opportunity to try for the VA work. 

    The new initiative in Wisconsin calls for creating digital health information systems at seven mental health facilities that are now largely paper-based and boosted by some facility-specific software applications.

    Wisconsin’s Department of Health Services operates three centers, two psychiatric hospitals, and two secure treatment centers for people living with developmental disabilities and mental health challenges.

    This article was updated on July 6 to add the statement from Epic.

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    The U.S. Department of Defense publicly stated that its Cerner EHR implementation will arrive on time at the Naval Hospital in Oak Harbor, Washington.

    DoD delivered that via a tweet carrying the message: “MHSGenesis will deploy at the next IOC site later this month,” from the handle @DoD_EHR by the Program Executive Office of DHMS, otherwise known as Defense Healthcare Management Systems.

    DoD Program Executive Officer Stacy Cummings changed the timeline in September 2016, citing previously unknown issues that arose during software testing and the need for creating the best user experience possible.

    Congress, in May of 2017, mandated that new quarterly timeline updates be added to the massive electronic health record modernization project, including schedule, costs and progress reports.

    [Also: DoD quietly rolls out EHR pilot MHS Genesis at Fairchild Air Force Base]

    A Cerner spokeswoman also said that "Oak Harbor will transition to MHS Genesis later this month." Indeed, while the Oak Harbor deployment has not technically happened as of press time — and EHR rollouts have certainly been known to change at the last minute — the public statement coming from DoD’s Program Executive Office indicates the next milestone will be reached.

    Veterans Affairs Secretary David Shulkin, MD, revealed in early June that VA intends to also adopt Cerner’s EHR. 

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    The IVD Industry Connectivity Consortium, a group working on standardizing data exchange between medical devices and information systems, has published a specification called LIVD that it says will advance health data interoperability by linking structured, coded data directly from diagnostic devices to laboratory information systems and other healthcare technology.

    "The main issue from a laboratory point of view is that there wasn't always a one-to-one relationship between a LOINC code and a test you would run on an instrument,” IICC President Serge Jonnaert said in statement. "We aimed to make that a fully plug-and-play solution. However, LAW did not cover vocabulary.”

    Now, LIVD maps in vitro test results directly to Logical Observation Identifiers Names and Codes, a code set used for identifying lab procedures and results. 

    The Regenstrief Institute, an Indianapolis-based health technology research organization, developed the freely available LOINC code set in the 1990s. Daniel Vreeman, director of LOINC and health data standards at the Regenstrief Center for Biomedical Informatics, said the harmonization of IVD outputs with lab coding was part of the early vision.

    LIVD is meant to complement the Laboratory Analytical Workflow profile created by Integrating the Healthcare Enterprise International, an initiative for promoting interoperability of electronic healthcare data. The LAW profile contains rules for exchanging orders and results between IVD devices and health IT systems.

    Jonnaert said that LIVD and LAW are "two synergistic standards” and LIVD took nine years to develop. Work accelerated last year when the IICC held discussions with multiple parties inside and outside of the U.S. government.

    Participants came from the National Institutes of Health, the Food and Drug Administration, the Office of the National Coordinator for Health Information Technology, Regenstrief, IVD makers, and software vendors, in a quest to "guarantee a one-to-one relationship," said Jonnaert, who is also managing partner of technology marketing consulting firm Tensei, based in San Clemente, California.

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    Customers of eClinicalWorks can breathe a little easier.
     
    As soon as word got out that the U.S. Department of Justice settled a False Claims Act case with eClinicalWorks, the company’s clients started asking whether they might have to pay back incentives for which they used the EHR vendor’s software to attest to meaningful use criteria.

    The good news came on Thursday. 
     
    “Providers that in good faith successfully attested using eClinicalWorks software and received an incentive payment will not have to repay the incentive payment,” a CMS spokesperson said late Thursday.  

    The DOJ on May 31 announced that eClinicalWorks agreed to pay $155 million to settle a False Claims Act lawsuit that involved giving customers kickbacks and fraudulently obtaining the certification necessary for hospitals to attest to meaningful use with eClinicalWorks software.

     Of that $155 million, $30 million went to the whistleblower Brendan Delaney, a former New York City employee who worked at the Riker’s Island prison. Delaney alerted authorities after finding several problems, including the software combining one patient’s record with that of another person as well medication module errors, security problems and tracking lab results incorrectly.

    The DOJ, for its part, charged that eClinicalWorks falsely obtained meaningful use certification by concealing its software’s limitations from the certifying body, added 16 drug codes necessary for certification into its software instead of enabling the EHR to access those via an external database, failed to accurately log users actions or record diagnostic imaging orders, did not equip the software to conduct drug-drug interaction checks and neglected to satisfy data portability requirements so doctors can transfer patient data to another EHR.

    The DOJ settlement hit eClinicalWorks hard. Not only is the $155 million a hefty chunk of the private company’s estimated $440 million annual revenue but, under terms of the agreement, the vendor must upgrade existing customers to a new version or transfer their data to a rival EHR, both free of charge. And the agreement mandates that it retain an Independent Review Organization watchdog to monitor eClinicalWorks activity for five years.

    But while eClinicalWorks will be more closely watched moving forward, its customers are now in the clear — at least from the viewpoint of CMS.

    “CMS realizes that providers may rely on the software they use for accuracy of reporting,” the CMS spokesperson said. “CMS does not plan to audit eClincalWorks providers based on the settlement under which eClinicalWorks has agreed to repay approximately $125 million to the Medicare and Medicaid EHR incentive payment program.” 

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    Cerner Corporation announced that Cerner chairman and CEO Neal Patterson died Sunday, succumbing to unexpected complications that arose after a recent recurrence of a previously disclosed cancer.

    Cerner co-founder and Vice Chairman of the Board Cliff Illig has been named chairman and interim CEO. 

    In the 38 years since co-founding Cerner, Illig has served as Patterson’s partner and close adviser, Illig served as Cerner’s president and chief operating officer over decades.

    “This is a profound loss,” Illig said in the statement released by Cerner today. “Neal and I have been partners and collaborators for nearly 40 years, and friends for longer than that.”

    “Neal loved waking up every morning at the intersection of healthcare and IT,” Illig added. “His entrepreneurial passion for using IT as a lever to eliminate error, variance, delay, waste and friction changed our industry."

    The Cerner Board of Directors has had a longstanding succession plan in place. The process to select a new CEO is nearing a conclusion, according to the company news release.

    Cerner President Zane Burke, who was named president in 2012, who has been the point man at the healthcare care IT company over the past several years, was not immediately available for comment.

    [Also: Cerner CEO Neal Patterson to undergo cancer ....]

    “One of Neal’s enduring ambitions for Cerner was to build a visionary company, not just a company with a visionary," said Illig. “He has done that. We have what I believe is the best management team in health IT, and we have associates who think as much about the future as they do the present. As a result, Cerner is well-positioned to have a pioneering impact on the provision of health care in the years to come.”

    Epic Systems founder and CEO Judy Faulkner, a longtime rival, who started her company in 1979, the same year Cerner was launched, agreed.

    "My deepest condolences go out to Neal’s family, friends, and colleagues. For nearly four decades, Neal’s vision and spirit helped transform the healthcare landscape in a way that will have a lasting impact for generations to come.” Faulkner said in a statement.

    When Patterson and Illig, both previously Arthur Anderson consultants, took Cerner public in 1986 they reported $17 million in revenue.

    Patterson announced in January 2016, he had been diagnosed with a “treatable and curable” form of cancer, and said he would begin treatment immediately.

     [Also: At Cerner, interoperability is personal.]

    Patterson’s home-town newspaper, The Kansas City Star noted today that Patterson was the son of Oklahoma tenant farmers.

    From those humble beginnings, Patterson and partners built a Kansas City-based healthcare IT enterprise that today employs 24,000 workers worldwide.

    Patterson took his place on the Forbes 400 list of billionaires in 2012 and has remained on it since.

    The company continues to win large contracts, the latest one a $50.7 EHR contract with the U.S. Department of Defense.

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    At the year's halfway point, we look back on Healthcare IT News' most popular stories, exploring major vendor announcements, general EHR dissatisfaction, rampant ransomware, innovative (potentially transformative?) technologies and more.

    Summer is often a time of slow news, but that's not the case so far this year: Three of our top five stories have been published since Memorial Day.

    Epic CEO Judy Faulkner reveals two new EHR versions are in development

    At HIMSS17 in Orlando, Healthcare IT News got a scoop that piqued the interest of our readers in a big way. "There's going to be three versions of Epic," longtime CEO Judy Faulkner told Editor-at-Large Bernie Monegain. In addition to the full bells-and-whistles version of the EHR, the Verona, Wisconsin vendor would soon unveil a mid-range "utility" version, and a system called Sonnet whose scaled-back features and lower price point could make it appealing to smaller providers. "We’re finding that people need different things," Faulkner said. "If you are a critical access hospital, you don’t need the full Epic."

    eClinicalWorks to pay $155 million to settle suit alleging it faked meaningful use certification

    EHR vendor eClinicalWorks agreed to pay a settlement of $155 million to resolve a charge that it had falsely obtained meaningful use certification for its software. Following a whistleblower lawsuit, the DOJ alleged that eCW added the 16 drug codes necessary for certification into its software rather than enabling the EHR to access those from a complete database, failed to accurately record user actions with audit log functionality, didn't always accurately record diagnostic imaging orders or conduct drug-drug interaction checks and did not meet data portability requirements designed to enable physicians to transfer patient data to over vendors' systems.

    Epic to jump into medical billing, currently hiring for new unit

    Given its sheer size and vast market share, Epic stories are perennially popular with HITN readers. When the EHR behemoth announced its entry into a new line of business, people took notice -- including, we're guessing, more than a few curious potential job-seekers in the greater Madison area.

    Nuance knocked offline by ransomware attacking Europe

    As the virulent Petya ransomware strain made itself felt around the world in most unwelcome ways, one of the largest providers of voice recognition software was a high-profile victim. Nuance Communications saw portions of its network affected, with many healthcare customers experiencing challenges with its transcription services and the Dragon Medical 360 medical dictation tool. Service disruptions continued as recently as this week.

    VA will move from VistA to a commercial EHR, secretary says

    "If somebody could explain to me why veterans benefit from VA being a good software developer, then maybe I'd change my mind," said Secretary of Veterans Affairs David Shulkin, MD, explaining why the agency would soon pick an off-the-shelf EHR to replace its self-developed VistA system. "But right now we should focus on the things veterans need us to focus on and work with companies who know how to do this better than we do." In June, to the surprise of few, it was announced that that company would be Cerner.

    AI, machine learning will shatter Moore's Law in rapid-fire pace of innovation

    What once sounded futuristic, perhaps even sci-fi, is now becoming commonplace at hospitals across the U.S. Artificial intelligence is set to become the new normal, enabling big strides in care improvement. "I've never in my career seen the acceleration of technology as fast as what we've witnessed in machine learning during the last two years," said Dale Sanders, executive vice president at Health Catalyst.

    Allscripts, Cerner, Epic signal more open EHRs ahead

    Humble old EHR systems also have some evolving of their own to do. And three of the leading vendors promised to embrace innovation and openness, most immediately by embracing open APIs, enabling third-parties to write software and apps to run on their platforms. Allscripts, for instance, already has some 5,000 developers certified to do that, and about 2 billion API exchanges have occurred on its platform since 2013.

    Doctors demand extreme EHR makeover ... right now

    The improvements wouldn't be a moment too soon. After years of complaints about poor usability, alert fatigue, workflow impediments and more Physicians' patience with the systems is wearing thin, and calls for big improvement -- sooner, not later -- are growing louder. “They need a tremendous makeover,” said Robert Wachter, MD, a professor of medicine at the University of California, San Francisco.

    CMS overpaid nearly $730 million in meaningful use incentives, OIG says

    In June, the HHS Office of the Inspector General revealed that the Centers for Medicare and Medicaid Services announced that it had inadvertently overpaid more than $729 million in EHR incentive payments to providers who hadn't actually met meaningful use requirements. That's hardly a rounding error -- the number represents about 12 percent of the total incentive payments for federal EHR Incentive Programs.

    Blockchain's potential use cases for healthcare: hype or reality?

    The next big thing, or just another over-promised fad? Blockchain is intriguing everyone in healthcare, and at HIMSS17, IEEE Computer Society and the Personal Connected Health Alliance sought to put digital ledger technology's potential into perspective, exploring real-world uses cases focused on security, interoperability, claims adjudication, clinical trials, master patient index, supply chain and more.

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    As eClinicalWorks faces a possible class action lawsuit and the potential for clients to switch to rival EHR vendors, some customers are coming forward with complaints about their treatment. The company countered that it is still signing up new healthcare organizations and at least one user has noticed the vendor changing its ways.

    At May’s end, the U.S. Department of Justice – in a settlement that included a $155 million fine– mandated that the EHR vendor either upgrade existing customers' software for free or transfer their data to a rival’s electronic health record platform.

    The questions arising now are how the vendor will move forward, what changes existing and prospective customers might expect and whether early indications that it is reinvigorating focus on customers will continue into the future.

    Customer complaints

    “We’ve been held hostage for a year and a half. I battled them,” said Laura Williams, practice administrator at North Spokane Women's Health in Washington. “It’s a nightmare with them.”

    Williams’ problems began nearly two years ago when North Spokane Women’s Health started the switch to GE Healthcare’s Centricity. When the clinic requested a copy of its patient data files, they were told that eClinicalWorks would charge $25,000 for the files, said Williams, noting that the offer was made without any guarantee that the data would be in a usable format.

    [Also: Concerned the eClinicalWorks fiasco could happen to your EHR? Take these steps now]

    “My doctors said ‘we’re not giving them another penny. We already paid through the nose,’” Williams added.

    eClinicalWorks spokeswoman Bhakti Shah responded that the company’s data ownership policy is clear.

    “Customers own the patient data. Anytime a customer cancels, eClinicalWorks offers the option to transfer the data on an eCW supplied or customer-provided hard drive,” Shah noted. “We are unsure what the customer means by eCW holding data hostage.”

    Improving lackluster service and support?

    Black Book managing partner Doug Brown has been conducting years of research about eClinicalWorks and its rivals in the EHR market.

    “eClinicalWorks clients revealed very low confidence when they scored corporate leadership, mismanaged marketing and sales mischief, and consistently terrible offshore contact center support service for the past six consecutive years of Black Book polls,” Brown said.

    And that is despite the fact that Black Book also consistently found eClinicalWorks scoring in the top 5 percent of physician satisfaction rankings dating all the way back to 2011.

    “eClinicalWorks product was found solid and priced to meet expectations,” Brown said. “But the performance indicators measuring the managerial accountability and ethics revealed the company’s clients were aware and speaking up about the issues. But they did not improve in the scoring between 2011 and 2017.”

    That could be starting to change since the DOJ settlement, according to client Andrew Tomkiewicz, IT director of Thundermist Health Center in Woonsocket, Rhode Island.

    [Also: DOJ will probe more EHR vendors for false claims, sources say]

    “If nothing else eClinicalWorks seems to be paying extra attention to customers now,” Tomkiewicz added. “I have seen an improvement in their responsiveness.”

    Black Book, in fact, conducted a post-settlement poll to gauge whether the company is ramping up its customer service.

    “It appears there is some notable improvement in the support to established clients,” Brown said. “Still, their reputation is sliding further in terms of trust, ethics, culture, accountability, transparency.”

    Shah, of eClinicalWorks, countered that its “independent team at eCW” conducts surveys. “We have great customer service and ratings and that’s the reason why our business is doing extremely well.”

    Former eClinicalWorks employee and current HIT consultant Justin Sleeper added that the company has long taken customers and employee enhancement requests seriously.

    “I made a number of recommendations while I was there,” Sleeper said. “From what I could see, eClinicalWorks was getting so many enhancement requests they had to prioritize which were best and those were the ones which were sent to product development for release into the system."

    Back in Eastern Washington, Laura Williams said that North Spokane Women’s Health had not paid the $25,000 charge and was not given the data files, so the clinic continued to use the eClinicalWorks application in read-only mode. That is, until the DOJ settlement was announced. On the next day, the system appeared to quit working.

    [Also: Not just Epic and Cerner: Hospitals have several EHR options if they abandon eClinicalWorks]

    Williams contacted eClinicalWorks, informing them she would file a formal complaint with the Office of the National Coordinator for Health IT — and that was the first time Williams said she ever heard back from the company same-day.

    “The IT people at eClinicalWorks never were able to fix the program errors, but our IT guy came up with a solution that at least has us able to access our patient records,” Williams said. “If I can get my patient data migrated to Centricity that will be enough.”

    Moving ahead but not yet revealing future intent

    In the weeks since the DOJ settlement, eClinicalWorks has publicized what seem to be three reasonably positive developments. And the Centers for Medicare and Medicaid Services added another of its own that is certain to help eClinicalWorks retain at least some customers.

    In early June, the company won a federally qualified health center contract with Ezras Choilim Health Center, in Kiryas Joel, New York, to provide eClinicalWorks 10e cloud-based software for EHR and population health services.

    Later in June, the vendor announced that it connected client Eagle Physicians & Associates with Cone Health, UNC-Chapel Hill Medical Center, Wake Forest Baptist Medical Center and Novant Health to exchange patient data with Epic EHRs. Eagle CMIO Robert Fried, MD, said the exchange entailed eCW putting “significant resources into interoperability and providing it to users at no additional cost.”

    The company also injected telehealth functionality into its Healow wellness app to enable doctors and patients to conduct virtual visit using smartphones and then import any relevant data directly into the EHR.

    What’s more, CMS put many customers’ top concern to rest on July 6 by revealing that it will not require eClinicalWorks clients to repay meaningful use EHR incentive money they earned using the software that fraudulently gained certification.

    Shah said that “eClinicalWorks had the highest sales this year in the month of June. And it was the best month for our pop health sales.” As with private companies, however, verifying that is another matter altogether.

    HealthcareIT News obtained a letter that eClinicalWorks sent to its customers stating that two weeks after the DOJ settlement it had signed 55 new customers, added more than 600 providers and is expecting to surpass 10,000 additional providers in 2017. It is also projecting revenues of $475 million in the core EHR and practice management space as well as $25 million from Healow.

    As for whether top executives intend to remake eClinicalWorks into a more customer-centric vendor or not, well, that remains elusive as of press time.

    Healthcare IT News repeatedly asked eClinicalWorks CEO Girish Navani to comment on future plans but he declined.

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    MGMA President and CEO Halee Fischer-Wright, MD, is a nationally recognized healthcare executive, physician leader, and coauthor of New York Times bestselling book, "Tribal Leadership." Her new book, “Back to Balance,” is due out in September.

    Prior to joining MGMA, she started her own successful medical practice early in her career, spent time as a management consultant, and served as president of Rose Medical Group in Denver, a 680-physician practice, for 12 years.

    We talked with her about the state of healthcare, what inspires her, the disparity in the workplace, mentoring and more.

    What drew you to a career in medicine?

    One of the benefits of having a non-traditional career in medicine. By healthcare standards, I’m halfway through my career. I’m of the people that when I was 8 years old, I wanted to be a doctor. There are no physicians in my family. In fact, at the time that graduated college, I was the first graduate from my immediate family.  My parents had not graduated. My mom subsequently went to college and graduated summa cum laude. It’s not like I had people in my family who were physicians.

    I was drawn to the interaction with families in such a big way. That’s why I pursued a career in medicine. I practiced for almost 20 years.

    I have a very asynchronous career path. I did lots of things at the same time. While I started my practice, I was also in leadership, first for the hospital and then for the physician organization and did that for 12 to 14 years.

    Then, I decided that physicians had negative business creditability, so I decided to go to business school to get an MBA. I went to the University of Southern California, and got my master’s in medical management. So, I was always focused on medical practice as a career path.

    While I was practicing medicine, I was also president of a medical group. So, I did that for a while until my husband was diagnosed with cancer, then I backed down and stopped consulting and focused on the medical group and practicing medicine.

    You must be so disciplined to be able to juggle as much as you did – and do.

    I’m not sure it was discipline or not. Sometimes, I think it was just crazy.

    What drew me to medicine, really is you want to make an impact. In my career as a physician, I recognized I can make an impact one-on-one – a patient seeing a physician. But I can make a much greater impact in the business of medicine, and positively affect many more than one at a time. I think that’s what drove me to do both simultaneously.

    What prompted you to seek executive positions?

    In leadership circles, a lot of people talk about influence vs. power. Really how I got into executive positions was pretty organically. I was just trying to extend influence to create a bigger impact.

    What is your biggest strength as a doctor? As an executive?

    As a physician, I think you would burn out – just from the burden that we place on physicians – and myself included. It got to the place where you really lose the joy of medical practice from seeing patients. The hardest thing was being burnt out and not seeing any relief.

    I have a book that will be coming out on Sept. 12 called “Back to Balance.”

    The biggest challenge in being an executive in healthcare, is I don’t see a lot of new leadership in healthcare. What I mean by that is that we tend to iterate on the same thing. We’re looking to make something incrementally better and not to take the risk of letting something go to move on to something that has the potential to be of much higher service. That to me is frustrating.

    Do you have an example?

    Let’s talk about electronic health records, for example. I was in practice when they first started to show up in early 2000. Really it was being sold as a way to provide better communication with all branches of medicine. And, as a sidelight, it really helps us facilitate the business aspects of healthcare. Where we are now, years later, the providers who use the health records are really dissatisfied with them. Instead of saying, you know, this is not working, should we scrap it and just take a look at something else, we just try to take the same system and iterate on them to try to make them better.

    What inspires you about your work?

    I love my job. I’ve had a lot of different career positions. This is my favorite one because it encompasses such rich and diverse organizations. It really has the power to transform healthcare in a positive way. And, that inspires me every single day. We are an organization that is going through change. Like most healthcare associations, we are re-evaluating what our relevance is to the marketplace, and in that transition, we are creating a vision of where we want to be in the future. And, to me, it’s incredibly exciting.

    Over your career have you encountered inequity in pay or otherwise?

    The answer is ‘yes.’ I think you could say almost through any level – in a variety of ways – not just personally, but I see it with my peers as well. I hear it all the time with my peers that are women CEOs. I speak very openly about “the unconscious bias.” Women in non-traditional women career paths technology, finance and the executive levels of healthcare. In healthcare about 80 percent of staff are women, yet less than 10 percent of the executives are women. So, there’s a huge disparity there. I know in the past – about five years ago – I was having a conversation, was negotiating my salary – and the professional talking to me about salary said: “well, you know, your husband is a physician, so you don’t need much.”

    Talk about mentorship

    Instead of talking about mentorship, what I really support – and what I role model – is sponsorship. I can push other women into positions where they can succeed. It’s not necessarily an “high-low: I’m the mentor, you’re the mentee,” but really almost a peer-to-peer sponsorship. That, I think, actually works a lot better. And it creates, I think, a much richer culture and much more inclusive culture with the women. It’s really a diversity issue – not just women that we’re struggling with in healthcare, and in technology.

    What are you reading?

    I read four or five books at the same time. I typically read a business book. It’s the genre I typically read on a plane. The last business book I read was “Originals” by Adam Grant; the biography of Einstein.

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


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    The death of Cerner CEO Neal Patterson due to unexpected complications from soft tissue cancer on Sunday night has colleagues and fellow health IT innovators grieving the loss of who most consider a pioneer in improving healthcare delivery.

    As Cerner is the second largest employer in Kansas City with about 12,800 employees in the region, much of the city is also feeling the loss:

    The city’s MLS team, Sporting Kansas City, which Patterson co-owned, said the health IT innovator focused on community-driven initiatives, while the Kansas City Manager called Patterson a titan “who helped build this town.”

    Patterson co-founded Cerner in 1979 with Cliff Illig and Paul Gorup with the idea of building a software company for the specific needs of healthcare. The founders recognized hospitals operated as silos and spent the last 38 years seeking to improve care quality and data sharing onto a common platform.

    Cerner built the platform during the 1980s, organizing health data by patient rather than the doctor, condition or payment method -- the first of many innovations. Patterson, along with Illig and Gorup, have continued to push the envelope with a mission of securely sharing data between disparate systems.

    Here is a timeline of a few Cerner milestones under Patterson:

    August 4, 2005

    Cerner won a 10-year, $51 million Department of Defense contract to supply the laboratory component of the DoD’s Composite Health Care System II, which would deliver the lab results to online medical records of 9 million service members, dependents and retirees.

    October 19, 2009

    Cerner joined with CDW Healthcare to offer Cerner’s electronic health record system to CDW clients, in an effort to help providers better adopt to healthcare technology. It was Cerner’s first partnership that offered the company’s full suite of ambulatory tools through a national channel partner.

    September 10, 2010

    Cerner forged partnerships with Ottawa Hospital, Children's Hospital of Eastern Ontario and Cornwall Community Hospital to implement an enhanced automated lab system that connects the three laboratories to local hospitals. Using Cerner’s Pathnet Laboratory Information System, operational and managerial sides of the laboratory are automated and connected lab data with the EHR.

    October 19, 2012

    Omnicell and Cerner partnered to drive interoperability between the firm’s technologies, allowing Omnicell products to connect with any Cerner EHR. The goal was to decrease implementation costs, time and maintenance for shared clients and provide new clinical workflows.

    March 4, 2013

    Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth announced a landmark collaboration: CommonWell Health Alliance. The goal? To move the needle on interoperability, enable care integration and data liquidity.

    September 22, 2014

    Cerner -- along with athenahealth -- pledged to develop apps able to interface with Apple’s HealthKit technology. The companies began working with Apple to develop patient-facing tools to make use of data aggregated from HealthKit.

    December 5, 2014

    Cerner -- along with Epic, Meditech, Mayo Clinic, Intermountain and Partners Healthcare -- joined HL7’s Argonaut Project. The project is designed to develop and expand the adoption of HL7 standards framework, FHIR.

    March 12, 2015

    Cerner partnered with digital health platform Validic to enable patients to stream clinical, fitness, wellness and nutritional data into their online portal and EHRs.

    April 17, 2015

    The health IT giant partnered with Geisinger Health System and xG Health Solutions to enable the use of SMART on FHIR industry standards, by facilitating the use of software applications across open platform EHRs, like Cerner’s Millennium.

    July 29, 2015

    The DoD awarded Cerner -- along with Leidos and Accenture -- the largest EHR contract at that time, valued at $4.3 billion. Under the contract, the companies will provide DoD with an off-the-shelf EHR, integration activities and deployment across the Military Health System.

    February 10, 2016

    Cerner launched an open platform dubbed Cerner Open Developer Experience designed to give third-party developers a sandbox to code pluggable EHR applications. The goal: to spur wider collaboration with third-party and client developers for SMART on FHIR applications.

    February 29, 2016

    U.S. Department of Health and Human Services Secretary Sylvia Burwell announced that Cerner -- along with Epic and Meditech -- pledged to use standardized APIs to drive patient access to data and to not block information sharing.

    July 13, 2016

    In an effort to make its multi-tenant network faster and improve its ability to keep pace with innovations and emerging technology, Cerner tapped BlueCat to automate and speed its cloud-based offerings.

    November 15, 2016

    Cerner and American Well partnered to connect EHRs to telehealth tools, which enables providers to virtually manage care from remote locations. Further, patients can interact with the software through Cerner’s patient engagement portal, giving access to health data, provider messaging and interaction with care teams.

    June 5, 2017

    The VA chose Cerner to replace its outdated EHR. The health IT giant will deploy and transition the VA enterprise to Cerner. At the moment, the cost of the new EHR has not been determined.

    Patterson spoke frequently on the need for interoperability and for health IT to work for better patient care: “It's time for vendors, even as they continue to compete in the marketplace, to break down their data silos… Our government is not going to deal with this problem."

    A mission for which his competitors and colleagues recognized as they took to social media to mourn his loss. Allscripts called Patterson a “giant in our shared mission to improve healthcare,” while Karen De Salvo called the loss “heartbreaking… The world has lost one of its giants, with a giant heart.”

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


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    Top leaders at the Office of the National Coordinator for Health IT offered a taste of what ONC’s main priorities are in the near-term and suggested where the agency is headed in the future.

    “When you think about what’s left, it’s the hard stuff,” National Coordinator Donald Rucker, MD, said during a press call on Tuesday morning. “Interoperability is an extremely tough issue.”

    Rucker said ONC is looking to modern computing tactics — notably open application programming interfaces that Silicon Valley companies such as Facebook and Twitter commonly deploy — to advance EHR interoperability.

    The questions ONC is grappling with now, in fact, are a clear definition of interoperability, improving EMR usability and a better understanding of information blocking.

    To that end, ONC is researching the best approach and that includes looking at existing and developing specifications such as FHIR or RESTful APIs such as JSON.

    “There’s a lot of interest in the FHIR standard, it’s a modern API, and we’re hoping there’s coalescence around that because the large vendors have already done some work with the SMART project,” he said. 

    But Rucker also noted that ONC must consider the API needs of hospitals and innovators as well. 

    “If I’m a Silicon Valley app developer I can’t hook up to a large national EMR vendor because the data is sitting with the providers,” Rucker said.

    John Fleming, MD, Deputy Assistant Secretary for Health Technology Reform said that achieving widespread interoperability will require more than just ONC and EHRs and, rather, also involves the reimbursement system.

    “We’re working to improve usability and interoperability but also how we reimburse providers,” Fleming said.

    That is where MACRA and the MIPs provisions specifically will be successors to the meaningful use EHR incentive program.

    “The evolution is going from meaningful use to quality measures, you can see them dovetail together in MACRA,” Fleming added. “Providers are continuing to have some of the meaningful use ongoing requirements and the added quality measures. The two together, it appears to me, mean quality measurement will overtake meaningful use.”

    Principal Deputy National Coordinator for Health Information Technology Genevieve Morris said that ONC will host three public meetings “meant to level-set where there’s alignment and where there’s not,” when it comes to health network-to-network data exchange. The meetings and subsequent public comments period will be used to craft a trusted exchange framework, which the 21st Century Cures Act mandates.

    “We hope to have a common agreement out for public comment later this year or early next year with the final sometime next year,” Morris said.

    Rucker explained that ultimately there is a broad sense in both Congress and the country that the healthcare sector can harness EHRs to become more efficient, not less so, because there is also a belief right now that EHRs are not working. And there needs to be seamless data exchange much like people experience with their smartphones — and the industry can do better by tapping into modern computer science. 

    “Pick the 10 apps you use the most,” Rucker added. “And ask yourself: Do I have that level of service in healthcare?” 

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


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    Despite more medical data being stored in EHRs than ever before, patients and caregivers still are struggling to access that information when and how they need it.

    “I don’t think patients would say they have free access to the data,” Donald Rucker, MD, head of the Office of the National Coordinator for Health IT said in a press call on Tuesday. “It’s patchy, and I think we can do better with today’s computer science.”

    To that end, ONC called for human-centered design methods to improve the process.

    [Also: SMS: The digital health tool of the century]

    “Human-centered design is a way of involving end users in developing and improving products,” ONC explained in the new guide “Improving the Health Records Request Process for Patients: Insights from User Experience Research.”

    The multi-disciplinary HCD methodology draws from cognitive psychology, ethnography and interaction design, ONC noted.

    Practicing HCD to create a more transparent electronic health records request system begins with building a foundation for enabling patients to request and receive records via a patient portal as well as establishing a system for requesting records outside of the portal and, ONC suggested, doing both in plain language instructions about how to make such requests and what to expect when doing so.

    With the foundation in place, hospitals should deploy e-verification technology to authenticate the identity of patients making any data requests, and ONC recommended including a progress tracker so those users can easily tell that their request has been received and when to expect delivery.

    It’s also important to make clear the various format options consumers have when requesting records, whether those are PDF or CD, and that they can be sent to either a personal e-mail address or to another care provider.

    Finally, ONC urged hospitals not to overlook the need to entice patients to actually use the portal and data request tools by selling them on the upsides, including the online appointment scheduling, medication refills and secure messaging features.

    “Whether you’re a provider, hospital staff, an innovator or a patient, everyone can work together to create a better experience for patients,” wrote Lana Moriarty, director of the office of consumer ehealth, office of programs and engagement, at the ONC, on the Health IT Buzz blog. “Patients and health systems have the same goal – to get the patient their medical records.”

    Healthcare IT News Editor-in-Chief Tom Sullivan contributed to this article. 

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


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