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    Seattle, Washington-based BloomAPI has raised $2.4 million for its medical records processing software. Y Combinator, Slow Ventures, Founder’s Co-Op, Section 32, Liquid 2 Ventures, and Parker Conrad all contributed to the round.

    HIPAA allows anyone to ask for and receive their medical records. But EHR systems aren’t always designed with an elegant way to get records out of the system, leading to a status quo where records are often printed out and then faxed, mailed, or hand-delivered to patients, as well as to insurance companies that might need them.

    BloomAPI is aiming to tackle that problem by installing a free software at practices that allow them to release records securely, easily, and electronically. The company has 300 doctors in its network currently and helps transmit records for more than a million patients.

    While the software is free to providers and sits on their existing systems, BloomAPI makes money by selling access to its API to insurers and other vendors. That product is called ChartPull.

    Interoperability between health records has long been a goal in healthcare, one that still seems a long way off. What’s interesting about the BloomAPI approach is that, rather than tackling the huge problem of enabling seamless data sharing between EHRs, the company is just trying to make the current status quo — record requests — a little more high-tech. While electronically requesting and transmitting records might not be as good as real data exchange, it’s still quite a bit better than printing and faxing.

    This is the first round of funding for the company, and it will go toward hiring engineering, operations, and sales staff in the Seattle area.

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    Electronic health record vendor athenahealth late Thursday posted a second quarter profit of $9.9 million due to a 15 percent jump in revenue compared to the prior year.

    The company pointed at expanding population health, ambulatory and hospital services as contributors to the $301.1 million in total revenue during the quarter, an increase from $261.9 million last year.

    [Also: Is a takeover of athenahealth inevitable?]

    Athenahealth’s profit followed a 2017 first quarter loss of $1.4 million and a $1.9 million loss in the second quarter of 2016. 

    The cloud services vendor also posted the revenue gains in a quarter that saw activist investor Paul Singer’s Elliott Ventures buy nearly 10 percent of the company’s stock, leading to speculation a sale or takeover of athenahealth might be in the future.  

    [Also: Former athenahealth CFO joins Arcadia Healthcare Solutions]

    Financial analysts even suggested that Apple could or perhaps should buy athenahealth as a way to gain a foothold in the healthcare market. CEO Jonathan Bush called those rumors baseless.  

    Between the first quarter’s close and athenahealth announcing the increased earnings, its chief financial officer, Karl Stubelis, left the company to take the CFO post at Arcadia Healthcare Solutions and board member Jack Kane stepped in as athenhealth’s interim CFO.

    Athenahealth’s stock was up more than 6 percent Friday on the news, trading at about $152 per share.

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


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    New York State official this week announced $18.7 million in grants six projects to help transform healthcare system in the Finger Lakes Region, including $5.7 million for one hospital’s Epic EHR installation.

    "Now, more than ever, we need to protect healthcare in New York and ensure the system in place is meeting the needs of current and future generations of New Yorkers," Gov. Andrew Cuomo said in a news release announcing the awards, which are part of a $1.5 billion commitment made by New York State to help healthcare providers across the state fund critical capital and infrastructure improvements, as well as integrate and further develop their health systems.

    [Also: Mayo Clinic kicks off massive Epic EHR go-live]

    Jones Memorial Hospital in Wellsville, New York, is among the hospitals benefiting from the statewide program. The hospital has been awarded a $5.7 million grant it plans to spend on an Epic EHR rollout.

    The multi-year project will integrate Jones Memorial with two other hospitals. All three hospitals are part of UR Medicine in New York State.

    The Epic EHR will make it possible for patient information to flow between Jones Memorial Hospital and its partners Strong Memorial and Highland hospitals, based in Rochester, New York.

    Physicians and specialists will be able to use one medical record system at each of the affiliate hospitals, rather than a different system at each hospital.

    The Epic system will replace Meditech and LSS technology that Jones Memorial has used since 1999.

    The timeline for implementation of the multi-year project begins with an IT work group to develop a plan for the project.

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    Meditech, which first joined the CommonWell Health Alliance in 2015, will begin offering its interoperability capabilities to clients early 2018, the company announced.

    First launched in 2013 by Allscripts, athenahealth, Cerner, Greenway, McKesson and RelayHealth, the alliance has since seen dozens of other IT companies joining vendor-neutral data-sharing initiative.

    Meditech was the largest subsequent EHR vendor to sign on with the group, as a contributor member.

    As a partner with HL7's Argonaut Project, the company will be among the first CommonWell members to deploy its FHIR specifications to its customers, including find document references and retrieve document resources, officials say – laying the foundation for even more comprehensive sharing of discrete data segments in the years ahead.

    Today, CommonWell services are live at more than 5,000 provider sites nationwide. In late 2016, the alliance announced a broader interoperability partnership with Carequality, which now represents more than 90 percent of the acute EHR market and nearly 60 percent of the ambulatory EHR market in the U.S.

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    DirectTrust is seeing solid growth in the number of healthcare providers using Direct protocols to share information, an increase in new addresses and is logging more transactions than ever.

    DirectTrust – which convenes participants using the Direct exchange network for secure data transfer – also added five new members since the beginning of the second quarter, the group said. Since April 1, five healthcare organizations have joined, bringing total membership to 129 organizations:

    [Also: Direct message transactions surging as the interoperability tool gains ground nationwide]

    Mirah specializes in what it calls measurement-based care, offering "MBC-as-a-service" to behavioral health practices. It’s products include: vitaTrackr data marketplace, facilitating the movement of health information from point of creation to qualified destinations authorized by the consumer; TechSoft, which develops customized practice management and electronic billing technology; PatientMD, a messaging app for patients and doctors; and Care3, an app that connects patients, their families and professional care providers.

    The number of healthcare organizations served by DirectTrust health information service providers and engaged in Direct exchange increased 68 percent to nearly 100,000, compared with the same period last year, according to DirectTrust's second quarter metrics.

    Meanwhile, the number of trusted Direct addresses able to share protected health information grew 15 percent to nearly 1.5 million.

    And there were 40.1 million Direct exchange transactions in the second quarter, an increase of 74 percent over the same period last year. The cumulative total of Direct exchange transactions reached more than 241 million at the end of the second quarter.

    "It is very satisfying to see the demand for Direct grow and to witness the physician and provider community further embracing the use of Direct exchange for secure messaging throughout hospitals and medical practices," said DirectTrust President and CEO David. C. Kibbe, MD, in a statement.

    "Vendors across the health IT industry are increasingly enhancing their usability for Direct, while health care providers are broadening their use of Direct beyond clinical messaging to include administrative and research communications," he said.

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    Embattled EHR vendor eClinicalWorks has circulated a letter to its customers outlining seven known parts of its software that it said could present an EHR certification issue.

    Healthcare IT News obtained a copy of the letter, which also outlines what eClinicalWorks has done about each issue since its landmark $155 million False Claims Act settlement with the U.S. Department of Justice in late May.

    The first issue is “The username field in the access logs may display as blank.” eClinicalWorks said it resolved this problem within the upcoming Q2-2017 Mandatory Patch and it recommended that users running the V10-SP1-C and V10-SP2 editions should update to the patch when it becomes available. Hospitals and medical groups using earlier iterations should update to the latest general release and then accept the patch.

    [Also: Customer says eClinicalWorks holding patient data 'hostage']

    Second, “the Modified By field on the patient’s Problem List may display as blank.” The company also will resolve this issue, which occurs randomly, with the upcoming Q2 mandatory patch and, as such made the same recommendations as the first issue in terms of installing the patch or updating to the most current edition and accepting it in the process.

    The recommended user actions get a bit more complex for the third issue, “Social history structured data discrepancy.” eClinicalWorks described the risk as a failure of social history data entries to update in the Progress Notes table for calculating social history measures for inactive programs on the back end. While installing the mandatory patch will fix the issue moving forward, the company also created a report containing patient records affected by this. “Once the patch has been accepted and installed, this report can be accessed form the Reports menu > Report Console. The Structured Social History Report is located under Advisory Reports.” Naturally, the company recommends users run the report and use the findings to identify patients with such discrepancies — and when such discrepancies are found update accordingly.

    In a vein similar to the preceding problems, the fourth issue, “imported CCD files do not display in patient documents preview,” occurs when CCD file sheets do not align with eClinicalWorks style sheet. The mandatory Q2-2017 patch will fix this problem, and the company said it created “a style sheet to display the CCD files in Patient Document preview pane.”

    That brings us to the fifth issue: “Incorrect issue date on the Drug Interaction window” and the letter notes that only the browser edition of V10-SP2 is susceptible. User action recommendations are the same to either patch current versions or update and, in so doing, accept the patch.

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

    Another issue, the sixth, also resides only within the browser version. “Printing Rx Education is missing in patient logs,” affects meaningful use Objective Measure 6 and will be corrected in the upcoming mandatory patch. “Until the patch is released for the browser instance, it is recommended that the practice print these materials from the executable .exe/desktop icon,” the letter said. “Rx Education printed from the Treatment windows or Common Send button in the executable instance does display in the Patient Logs.”

    The seventh and final issue: “Printing patient education missing in patient education logs,” is also only found in the browser version and pertains to meaningful use Objective Measure 6. 

    eClinicalWorks did not say in the letter when the Q2-2017 mandatory patch will become available and did not respond to queries asking for that date as of press time. 

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    Physician office IT costs are rising as much as $2,000 to $4,000 more per physician compared with the prior – totalling $14,000 to $19,000 annually per doctor, depending on specialty, according to the 2017 MGMA DataDive Cost and Revenue Survey released this past week by the Medical Group Management Association.

    Between 2015 and 2016, operating expenses for practices increased at nearly the same rate as revenue, according to the survey.

    Those costs – which include purchased IT (maintenance of electronic health records and patient portals, for instance) and contracted expenses for upkeep of hardware and software – are less for hospital-owned practices, however.

    Practices that were able to bolster their bottom line often did so with help from non-physician providers and support staff, according to MGMA. Practices with a higher NPP to physician ratio – 0.41 or more NPPs for each full-time equivalent physician – earned more in revenue after operating cost than those with fewer NPPs, irrespective of specialty.

    Those with more support staff also showed increased productivity, the survey showed.

    "Contrary to what some may believe, with increased staffing come much larger gains in revenue after operating cost, as well as productivity," said Halee Fischer-Wright, MD, president and CEO at MGMA, in a statement.

    MGMA's Cost and Revenue Survey was based on comparative data of more than 2,900 organizations and 40 specialties and practice types.

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    A bill introduced last week by Reps. Lynn Jenkins, R-Kansas, and Doris Matsui, D-California, would promote incentive payments for behavioral health providers who purchase and adopt electronic health records.

    The proposed bill would apply to community mental health centers, public or private psychiatric hospitals, accredited residential or outpatient mental health treatment facilities, accredited substance abuse treatment sites, clinical psychologists and clinical social workers.

    The bipartisan legislation is part of the Centers for Medicare and Medicaid Services Innovation Center project to promote not only the adoption of certified EHR systems, but to use the technology to improve the coordination and quality of care through health information exchange.

    While meaningful use has been successful in increasing EHR adoption, the representatives said that behavioral health providers were excluded from the program and lack the funds to implement full EHRs.

    The proposed project would allow congress to avoid expanding meaningful use to cover mental health providers.

    “This is another step forward in our work to put mental health on a level playing field with physical health care,” said Matsui in a statement. “By encouraging the use of EHR technology by behavioral health providers, we can improve care coordination and behavioral health integration. That helps ensure patients receive the treatment they need in the right place at the right time.”

    The CMS Innovation Center has been considering potential payment and service delivery models focused on behavioral health, as well as telemedicine. CMS will hold a Behavioral Health Payment and Care Delivery Innovation Summit to address workforce challenges in the mental health field and reimbursement for the use of telehealth.

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    Despite the fact that close to 90 percent of providers participating in meaningful use offer their patients online access, only about one-third of patients actually log in to see their data, according to the U.S. Government Accountability Office.

    On the GAO's WatchBlog, the agency explored some of the reasons for that. Part of it has to do with the confusion of keeping tabs on separate portals for different providers, officials said.

    "Patients often receive access to a different portal for each provider they visit, and must manage separate login information for each one," according to GAO. "The patients we interviewed were frustrated with the amount of time and effort it took to set up these portals, understand each portal’s user interface, and manage all the different passwords."

    [Also: GAO official: VA must improve clinician productivity tracking]

    And despite providers' efforts to offer access to information about labs, meds, allergies and more, many patients say the "information available to them was incomplete and inconsistent across providers, and were unclear about whether it could be electronically downloaded, transmitted, or aggregated in one place."

    Those patients who did use online portals said they liked being able to communicate with their physicians, schedule appointments online, refill medications and share their own data with other providers.

    But more needs to be done to encourage active patient engagement with their health records, said GAO officials, who this earlier this year issued a pair of recommendations to the U.S. Department of Health and Human Services:

    First, HHS should direct the Office of the National Coordinator to develop performance measures to track its efforts related to patients' access to longitudinal health data.

    "Such actions may include, for example, determining whether the number of providers that participate in these initiatives have higher rates of patient access to electronic health information," according to the report.

    Second, ONC should use that information to tailor its patient engagement efforts as needed – for instance, "assessing the status of program operations or identifying areas that need improvement in order to help achieve program goals related to increasing patients' ability to access their health information electronically."

    Of course, given the steep budget reductions ONC could soon be facing, it remains to be seen whether those recommendations will gain traction.

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    Rolling out new electronic health record systems puts hospitals at a significant risk of financial losses, according to a new report by credit rating firm Moody’s.

    “Hospitals run the risk of incurring operating losses, lower patient volumes and receivables write-offs if there are problems with adoption of a new EMR system,” Moody’s said in its Monday report.

    Add to that the operational and financial disruptions that typically accompany complex IT projects, and hospitals could find themselves walking an even thinner financial margin than they are used to, Moody’s said.

    “In a sample of hospitals that have recently invested in major EMR and revenue cycle system conversions, increased expenses and slower patient volumes contributed to a median 10.1 percent decline in absolute operating cash flow and 6.1 percent reduction in days of cash on hand in the install year,” Moody’s found.

    The good news is that many hospitals returned to pre-install levels within a year, owing to strong risk management.

    When Epic Systems founder and CEO Judy Faulkner talked with Healthcare IT News at HIMSS17 last February, she said Epic customers had done well financially. True, Epic EHR installations cost millions of dollars. However, from 2004 to 2015, she said Moody’s and Standard & Poor's statistics showed that Epic customers reaped profitability unsurpassed by clients who implemented her competitors’ EHRs.

    [Also: Epic CEO Judy Faulkner reveals two new EHR versions are in development]

    Despite the risks, hospitals will continue to invest in EHRs, Moody’s said. Hospital executives want to improve patient safety, clinical quality and provide decision support. IT will also continue to be a selling point in physician recruitment and retention, as new data reporting will be required by Medicare for professional reimbursement.

    While hospitals may be exposed to a number of risks during massive IT rollouts, the threats that come with cyberattacks make them even more vulnerable, according to Moody’s.

    As example, Moody’s points to Hollywood Presbyterian Medical Center in Hollywood, California, which acknowledged paying ransom after an attack in 2016.

    [Also: Hollywood Presbyterian gives in to hackers, pays $17,000 ransom to regain control over systems]

    Moody’s expects cybersecurity to become an even stronger focus than it already is.

    “As IT investments represent a growing portion of hospital budgets, an increasing amount will be allotted to guarding confidential patient data, which make hospitals a prime target for cyberattacks and ransomware events,” according to Moody’s. “We expect cybersecurity to be a primary focus of hospital management teams and their boards, with annual capital and operating budgets allotting appropriate levels of expenditures to protect patient data and testing vulnerabilities.”

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    CVS Health and Cleveland Clinic are expanding their eight-year clinical affiliation, building on the relationship between MinuteClinic and Cleveland Clinic to enhance care for Northeast Ohio and Florida patients.

    The expanded relationship includes CVS Health joining Cleveland Clinic's Quality Alliance, a large clinically integrated network of providers collaborating on chronic disease management-focused quality measures.

    The two organizations will share standard protocols, quality metrics and examine population health data. They will also create joint clinical programs to deal with high rates of chronic diseases and help patients better manage their medications, CVS Health said in a statement.

    MinuteClinic, CVS Pharmacy and Cleveland Clinic will also focus on streamlining and enhancing communication through their electronic health record systems. This effort includes electronic message and alert sharing regarding prescription information, visit summaries, diagnosis and treatment protocol directly between the treating physicians and CVS Pharmacy and MinuteClinic provided the patient gives consent. 

    "The care coordination and communication between healthcare providers deliver a more comprehensive view of patients, which is integral in health care decision-making and disease management," CVS Health said.

    "This collaboration enhances the quality of care patients will receive and allows us to oversee their care more seamlessly than we do today," said Michael Rabovsky, MD, chairman of the Cleveland Clinic Department of Family Medicine. "As part of our Quality Alliance, CVS Health joins our clinically integrated network which uniquely positions us to share treatment guidelines and protocols and puts the patient at the center of a larger system of care when they need it."

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    HIMSS has named Harold "Hal" Wolf III to be its new president and chief executive officer, following an extensive search process, the association announced Wednesday.

    He will succeed H. Stephen Lieber, who is stepping down as HIMSS CEO after more than 17 years.

    Wolf has more than three decades of experience working in healthcare and technology, with deep expertise in integrated care models, consumer engagement, broadband and other IT innovation.

    [Also: HIMSS CEO plans to step down in 2017]

    Most recently, he has served as director of information and digital health strategy at The Chartis Group, where he helped health systems in the development of integrated information, operations, digital health and precision medicine strategies.

    Prior to that, Wolf spent 10 years as chief operating officer of Kaiser Permanente's Federation, where he focused on care delivery, data governance, population health management and more.

    He also worked as chief information officer for Quest Communications/USWest, and started his career in the media industry at MTV Networks and Time Warner, where he was an innovator in the development of video on demand and broadband.

    Wolf has served HIMSS for four years, as an advisor to the board and as a member of the board of directors, and recently as vice chair. He also serves as a board member and officer of the International Care Delivery Alliance.

    "The search process focused on finding the right candidate possessing some key characteristics: healthcare and technology expertise, global experience and prior work in and with both for-profit and not-for-profit companies," Lieber said. "Hal checks all of these boxes in spades.

    "Hal is a globally respected thought leader and he has been part of the HIMSS leadership as a board member for the past four years," Lieber added. "He knows the issues and he knows the organization. That's an incredible combination and contribution to HIMSS' work to achieve better care through IT. "

    "Hal Wolf brings to his new role as president and CEO of HIMSS the powerful combination of broad, deep and relevant knowledge, expertise, experience, energy and accomplishments, along with a deep love of and longstanding commitment to HIMSS," said Michael Zaroukian, MD, HIMSS board chair. "His track record of innovation and success spans premier healthcare delivery organizations, digital strategy groups, media companies, global endeavors and more."

    Wolf is expected to start in September 2017 and will assume the full duties of president and CEO by the end of the year.

    "It is a great privilege and honor to be chosen to lead HIMSS, an organization whose purpose is to improve healthcare and care outcomes," said Wolf.

    "Across the globe, healthcare is challenged to harness the power of information and technology, to solve for the unique environments of each health system and to support the personalization of care to the individual," he added. "In alliance with the growing membership of HIMSS and the expansive capabilities of our organization, our collective task is to enable innovation across the full healthcare ecosystem."

    HIMSS is the parent company of Healthcare IT News.

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    After 18 months of planning, Hagerstown, Maryland-based Meritus Health has signed off on a $100 million rollout of an EHR system from Verona, Wisconsin-based Epic Systems.

    The cost will be distributed over five years.

    The decision process included more than 1,000 Meritus employees and officials, according to Herald-Mail Media.

    Meritus Health executives reviewed six vendors and evaluated two finalists in-depth. For the two finalists, Meritus officials visited a company client, a similar community-based medical system with 250 to 300 beds.

    "Clinicians particularly preferred Epic," Meritus President and CEO Joseph P. Ross told Herald-Mail Media.

    Go-live is slated for next summer.

    Epic will provide technology for both health records and billing, Meritus officials said.

    [Also: Epic CEO Judy Faulkner reveals two new EHR versions are in development]

    Meritus Health employs 2,500 people. It is a not-for profit healthcare system. Meritus Medical Center, the health system’s flagship facility has 243 beds. It serves the residents of Washington County and western Maryland, southern Pennsylvania and the eastern panhandle of West Virginia.

    Meritus will use its reserves, including federal funds it received under the Affordable Care Act, to pay for the project, Ross told Herald-Mail Media.

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    Amazon has started a secret lab at its Seattle headquarters to explore business prospects in the healthcare sector, including EHRs and telemedicine, according CNBC. That report comes on the heels of swirling rumors that Apple is in talks with hospitals and other healthcare organizations to explore the possibility of bringing health records together on the iPhone. 

    It’s important to note that press reports thus far are based on unnamed sources and industry analysts speculate that even for the likes of Amazon and Apple stealing customers away from Epic, Cerner and Allscripts would likely be a difficult and lengthy process. 

    Amazon is reportedly considering developing an EHR platform as well as telemedicine and health apps for existing devices, such as its Echo. 

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

    Amazon has dubbed the covert team “1492,” the year Columbus first landed in the Americas, and it is hiring for positions that are searchable on Amazon using the keyword “a1.492.” The crew is also working on healthcare applications for Amazon devices, such as Echo and Dash Wand.

    Apple, for its part, already has a big toe in the healthcare market with its HealthKit and ResearchKit apps, Apple Watch, and work with Health Gorilla to add diagnostic data to the iPhone, including measures such as blood work, by integrating with hospitals, lab test companies and imaging centers. 

    The Cupertino, California giant has also recently hired people with top healthcare credentials who are savvy in the digital realm.
     
    In seemingly unconnected news, President Trump today announced Apple CEO Tim Cook had promised to build three big manufacturing plants in the U.S. Cook has been mum on the announcement.

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    Customers of eClinicalWorks are more or less of two minds about their EHR vendor's recent legal settlement with the U.S. Department of Justice, says KLAS Senior Research Director Erik Bermudez.

    Reaction ranges from, "Yeah, this leaves a bad taste in my mouth but I'm not really going to do anything about it," to, "You know what, this news really pushed me over the edge to the point where I'm absolutely going to make a switch," he said.

    Actually, the eClinicalWorks' client base is currently divided fairly equally into thirds, according to the KLAS report: Those planning to jump ship, those who "feel stuck in their contract but would like to switch and may do so when their contract expires," and another third who are still satisfied with their customer experience.

    [Also: What eClinicalWorks just told customers about 7 known certification risks in its EHR]

    While 34 percent of the providers surveyed plan to migrate to another vendor, however, only 4 percent specifically said they're leaving because of the settlement.

    Still, that number could shift in the months ahead. The DOJ compelled the vendor to agree to a series of conditions that would make migration to a competitor easier than it ordinarily would be. On one hand, the corporate integrity agreement signed by eClinicalWorks calls for customers to get software updates free of charge. On the other, it compels eCW to transfer data to competitors' EHR "without penalties or service charges," if that's what customers ask for.

    "I spoke to many eClinicalWorks customers who have expressed interest in leaving, and as they have those discussions with eClinicalWorks there's a pretty big price tag – an "exit fee" – to get their data off eCW and onto the new platform if they switch to a competitor," said Bermudez. "So having that (fee) off their plates if they do decide to leave is huge."

    At the same time, a small percentage of eCW clients said the aftermath of the DOJ settlement has actually increased their esteem for the company.

    "I talked to one CEO of a pretty large customer who said, 'What's interesting is this actually enhanced my impression of eClinicalWorks and brought us closer in terms of a working relationship,'" said Bermudez.

    "He said, ‘Within 48 hours we had individual phone calls, numerous calls, with their CEO and their CMO to discuss how this happened, what oversight eClinicalWorks had, and what processes are now in place to make sure this doesn't happen again. And how is the company going to lift themselves back up to hold themselves to a higher standard based upon what they did in this settlement."

    But wasn't the norm, he said. In addition to tracking customers' migration plans (or lack thereof), KLAS also sought to assess just how the settlement news affected clients perceptions of eClinicalWorks.

    There, the numbers were a bit more decisive. Nearly two-thirds of eCW customers said they're downgraded their opinion about the company. More tellingly, "about one fifth describe the settlement using words like 'unsurprising,' indicating that their personal concerns about the vendor's ethics and business practices have now been confirmed," according to the report.

    Healthcare CIOs quoted anonymously in the report pointed to low expectations for the beleaguered EHR vendor.

    [Also: Healthcare pros more suspicious of all EHR vendors after eClinicalWorks scandal]

    "I wasn't surprised to hear what eClinicalWorks has been doing," said one. "They have been cutting corners, and it has caught up to them. I feel like I have a good relationship with them, but we are already in a mode to replace them. We are just deciding who to go with. This news just makes me double down on my opinion that eClinicalWorks is not doing things the right way."

    "None of the legal issues surprised us," said the another. "We have complained repeatedly over the years about many of these issues, such as poor software control, the lack of change control, and the lack of a process for addressing patient-safety issues or tracking. Our belief is that eClinicalWorks will not be able to develop the business structure needed to address these issues."

    Still, a few others were more optimistic. 

    While the report found that most users now view eClinicalWorks more negatively than they did before, a small group – few than 5 percent of those surveyed – feel the increased governmental oversight will lead the vendor to improve.

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    Since its settlement with the Department of Justice in late May, eClinicalWorks has been under fire for its business practices but it has also been winning new customers.

    The company said on Friday, in fact, that second quarter sales for 2017 topped $120 million on its EHR, patient engagement and population health software and cloud services.

    Healthcare IT News Editor-in-Chief Tom Sullivan spoke with eClinicalWorks Chief Executive Officer Girish Navani about what the company learned since the settlement and where it will focus its efforts moving forward.

    Q: It would appear that eCW’s momentum has continued despite the DOJ settlement — what do you attribute that to?

    A: Customer satisfaction. At the end of the day we have a pretty solid product line and success has been good for 17 years. That’s the number one thing a company does, take care of customers, innovate, provide a good price point. We have a track record of that and I would say we’ve been even more focused on that during the last year so we will see that momentum continue.

    Q: KLAS published research this week that found 34 percent of your customers are planning to switch EHR vendors though only 4 percent said it was because of the settlement – so why are so many leaving now?

    A: I don’t know about those numbers but I know we have 15,000 customers. I don’t know if they talked to 1,500 of them or 50 of them but we continue to see not only new business but growth with existing customers, expanding with population health and patient engagement. So I don’t agree with that. I don’t know if the sample size is big enough to understand what it is in terms of the big picture. Focus on customers, do the right thing, and you’ll be fine.

    Q: I have heard from a number of clients that eClinicalWorks — and I’m quoting one here who said “there is absolutely zero question they hold customer data hostage” — how do you respond to that?

    A: Well, Tom, we responded to that with you earlier. We sent you the formal copy. Objectivity in any discussion is paramount. We have a formal process in the company to return all the data on a hard drive. I don’t know what one customer wants to say to you. All I know is we have a formal process. We return practice management an EMR data because our contract is black and white, whether in cloud or on premise, data belongs to the customers. Not just discrete data, all the data, scanned documents as well. If they exercise the right to take it, they get all of data.

    Q: Actually, that was only one of the people who reached out to me. There were multiple customers sharing that sentiment …

    A: You can send them that document we sent to you that outlines all the options. You can send that to them and if they select it and then come back and tell you that eClinicalWorks does not respect that document, then we should have a conversation. I cannot qualitatively speak to an individual commentary you. What I can speak to is our customer services department standard operating procedure — meaning, if that request comes, that’s what the person has to do. They send that document over and the customer has a choice of what they want to do.

    Q: What has eCW learned since the settlement? How is the company changing?

    A: There are some things that stay the same and some things have to change. Product development and innovation has to continue. That’s one foremost principles of a tech company or else you get superseded in the technological innovation curve, that happens to any company that stays stagnant. Version 11 will come out in October at our national conference and it will have newer models around teleheath and patient engagement and new product innovations in population health in terms of risk and predictive analytics.

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

    What has to get complimented along with this is the area of compliance. I would contend this is important for every electronic health record vendor to now recognize that everyone needs to respect meaningful use, check against criteria. We do. We have a compliance program that can be measured against every check and balance in that criteria and executed in a way that does not allow any non-conformity. That’s the focus in my workplace and I would broadly say that any of the 700 in our industry should focus on the compliance side of regulatory requirements alongside innovation because that’s the expectation of our industry going forward.

    Q: So given the compliance program you mentioned, what exactly happened? What lead to this DOJ settlement?

    A: Tom, some day when we are talking years from now, yes. But now going back is not my purpose anymore. It’s a chapter that has to be closed and we move on. I can commit this to you: Back to normalcy and working, more focus on product innovation and customer service, and a tighter compliance program. What happened, why it happened, how and why we handled it, nobody will win with that discussion. It’s not worth it.

    Q: I have reached out several times for comments post-settlement and was told you did not want to respond, so why go on the record now?

    A: I wasn’t trying to ignore your requests. My priority was my customers, I was nonstop engaging with my clients, I was nonstop traveling as well. I’m not making that as an excuse. When you’re asking about my business, about product innovation, I’d be happy to talk to you. Call me four weeks later and I’ll talk to you again to tell you what happened in the last four weeks. 

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    Cerner's bookings rose 16 percent to a best-ever $1.6 billion in the second quarter of 2017, company officials said on Thursday.

    Revenue for the second quarter was in line with the company's guidance range at about $1.29 billion, up 6 percent compared to $1.21 billion for the same period in 2016.

    "We are pleased with our execution in the second quarter, which included all key metrics being within or above our targeted ranges," said Cerner President Zane Burke. "Our record bookings reflect Cerner’s strong competitiveness and good marketplace activity."

    [Also: Remembering Cerner CEO Neal Patterson's health IT legacy]

    The earnings call was significant for the company in another way. It was the first since the passing earlier this month of co-founder and CEO Neal Patterson.

    "It's been tough for us these past few weeks," said Cerner Chief Financial Officer Marc Naughton. "And we appreciate the many people have reached out to offer condolences and share their thoughts and stories about Neal."

    He added that "the best way to honor his legacy is to keep up the very hard and important work toward achieving the vision he established."

    [Also: DoD rolls out Cerner EHR at second military site]

    Burke said 35 percent of bookings came from long-term contracts, with 32 percent of bookings coming from outside the company's core Millennium install base.

    "One of the many noteworthy new relationships this quarter was established with LifePoint Health, a large investor-owned health system that owns and operates more than 70 hospitals and has a significant number of post-acute and outpatient facilities," said Burke. "The contract currently covers a small group of sites that can be expanded to future sites as necessary and includes clinical revenue cycle and ambulatory solutions as well as remote hosting."

    He cited particular success at smaller providers, which adopted Cerner's ambulatory and CommunityWorks products, the latter of which also posted all-time high bookings.

    "I remain pleased with our competitiveness and the amount of activity in EHR placement market," he added. "Our new footprints this quarter again demonstrate the trend of hospitals, large and small, looking to get off legacy systems to be on a more modern platform, keep up with regulatory requirements, drive operational efficiencies and prepare for ongoing shifts in reimbursement models."

    Burke also offered updates on Cerner's work the U.S. Departments of Defense and Veterans Affairs.

    Earlier this month, the DoD's MHS GENESIS project went live at Naval Hospital Oak Harbor in Washington State, the second site in what will eventually grow to be a worldwide multi-wave deployment over the the coming decade.

    "We expect additional go-lives as we move through the year," said Burke.

    MHS GENESIS is "creating an integrated and longitudinal patient record and coordination across the continuum of care regardless the environment, scope or size of military and dental treatment facilities," he added. "The ability to integrate and share interoperable patient information with the U.S. Department of Veterans Affairs and civilian health systems is critical and is inherently built into the system."

    As for the VA, which tapped Cerner in June for its own next-generation EHR at a price tag that's yet to be decided, Burke said the company is "working closely with the Department of Veterans Affairs on scoping the full work effort, designing the project plan and negotiating a contract. We're also in the process of building our team and selecting partners."

    Beyond that, "there is little more we can say at this point," he said – adding that there will be more information forthcoming when a contract is finalized, "which we believe will happen by the end of the year."

    In the meantime, Cerner execs noted that the company expects revenue in the third quarter to be between $1.26 billion and $1.33 billion with the midpoint reflecting growth of 9 percent over the third quarter of 2016.

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    The outpatient electronic health record system market is an epic market – one might also say it’s an Epic market.

    When purchasing a new ambulatory EHR, or replacing or upgrading an existing ambulatory EHR system, 51.4 percent of healthcare provider organizations are considering EHR vendor Epic, up from 45.1 percent in 2016, according to the new HIMSS Analytics 9th Annual Outpatient PM and EHR Study.

    [Also: One-third of eClinicalWorks customers prepping to switch EHR vendors, KLAS says]

    “The market has gone back and forth for decades around the benefits of best of breed versus a single, integrated solution,” said Bryan Fiekers, senior director of research services at HIMSS Analytics. “As healthcare drives toward accountable care and value-based care, the integration of solutions and the flow of data across the enterprise becomes more critical.”

    Health systems are working to migrate their outpatient facilities from disparate solutions to a more enterprise-based platform, and it just so happens that Epic does fairly well on the inpatient side as well, he added.

    The HIMSS Analytics study shows soaring interest among providers in the EHR of athenahealth. 25.7 percent of providers looking for a new outpatient records system or seeking to replace or upgrade a system are considering athenahealth, up from just 7.4 percent in 2016, the study found.

    [Also: Healthcare pros more suspicious of all EHR vendors after eClinicalWorks scandal]

    “While Epic started with the inpatient market and rolled out to the outpatient, athena took the opposite, more grassroots approach, starting in the outpatient environment and climbing up the ladder to inpatient,” Fiekers said. “Ultimately some of the same forces behind Epic’s success are at play with athena.”

    Additionally, athenahealth has done a good job of marketing its differentiated solutions to the industry, he added, and organizations are becoming more comfortable leveraging the cloud. As that happens, athenahealth’s value proposition increases, he said.

    Among other EHR vendors, 17.1 percent of providers are considering Cerner, down from 21.3 percent in 2016; 15.7 percent are looking at embattled vendor eClinicalWorks, up slightly from 15.6 percent in 2016; and 14.3 percent are considering Allscripts, up from 13.9 percent in 2016, found the study, which examines many other vendors, as well.

    Vendor eClinicalWorks recently was slapped with a large legal settlement by the U.S. Department of Justice. According to a recent KLAS study, 34 percent of providers with an eClinicalWorks EHR plan to migrate to another vendor. However, only 4 percent specifically said they’re leaving because of the settlement.

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    What with rumors swirling that Apple and Amazon are each considering ways to drive deeper into healthcare, including EHRs and telehealth, it’s time for a reality check.

    The central question is whether even technology stalwarts such as Amazon, Apple and their ilk could, in fact, build an EHR from scratch and then gain enough market share to make the whole endeavor a worthwhile investment.

    Yes, if anyone could accomplish that feat, Amazon and Apple are chief among them. But there’s more to it.

    It is perhaps a telling indication of how difficult the task would be that one EHR vendor CEO actually said he welcomes Apple and Amazon into the marketplace.

    [Also: eClinicalWorks CEO Girish Navani speaks: 'This chapter has to be closed']

    “I love competition,” eClinicalWorks chief Girish Navani said. “Would you prefer the Super Bowl be played with only one team showing up and the trophy being handed out after 60 minutes? No, competition makes everyone better.”

    Navani added that he doesn’t have any insights about Amazon or Apple’s EHR plans. “If they want to do that, great. We believe in our innovation cycles as well, and as long as the industry moves forward we will have a share.”

    Two prominent industry analysts said that any play for a significant piece of the healthcare sector by these two tech giants – such as building a new EHR – would likely prove dubious.

    "It will be an uphill battle, especially if they try to compete in the larger segments of the market," said Bryan Fiekers, Senior Director of Research Services at HIMSS Analytics. "If ever there was a long play, this would be it."

    John Moore, founder and managing partner of Chilmark Research, added that many enterprise technology titans have struggled to tackle the healthcare IT conundrum.

    “Think Microsoft, Google and IBM with very mixed success,” Moore said. “Thus, it is difficult to get too excited about rumors around Amazon and Apple's potential plays in this market sector.”

    It’s worth pausing to note that what has thus far been reported is based on unnamed sources — meaning neither Apple nor Amazon has formally revealed any intentions to build an EHR.

    That means whatever work the vendors are doing, even if it is currently on developing electronic health records software could, in time, take on a different shape than the EHRs companies like eClinicalWorks, Epic, Cerner, Allscripts and athenahealth -- which financial analysts said Apple should acquire -- currently offer today.

    Indeed, rather than trying to displace the current crop of EHRs, Chilmark’s Moore speculated that the companies would likely target the next level above the EHR to enable consumers to better control their own health data.

    “Having aggregated this data,” Moore said, Amazon or Apple could potentially repurpose health data, with consent, for research such as drug development or patient reported outcomes.

    Healthcare IT News editor-in-chief Tom Sullivan contributed to this report. 

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    Atul Butte, MD, pediatrician and computer science leader, has been named the Priscilla Chan and Mark Zuckerberg Distinguished Professor at UC San Francisco, where he takes the reins at the Institute for Computational Health Sciences.

    The $10 million gift from the Silicon Valley philanthropists Chan and Zuckerberg will launch the institute and support Butte’s work.

    Butte also serves as the executive director for clinical informatics across the six University of California Medical Schools and Medical Centers.

    First up on his to-do list, Butte, a pediatrician and computer scientist, intends to bring more statistical power to his work. He is overseeing a project to integrate EHRs from all five medical centers in the UC system, which collectively hold the records from 15 million or more patients.

    “This is among the richest and most diverse medical datasets in the world – much more than just a set of billing codes,” Butte said in a statement. “And, because the data come from our patients, the data are an incredible resource for UC hospitals to improve the quality of care we deliver throughout California.”

    At medical centers like UCSF, EHRs are increasingly being looked to for insights on how to improve the quality of care and to better understand disease, Butte noted. For example, UCSF physicians used the medical record system to institute a virtual glucose monitoring system. Over three years, the system helped to reduce the proportion of patients who were hyperglycemic by nearly 40 percent.

    [Also: Atul Butte: Precision medicine makes doctors nervous]

    Butte is also advancing an method to research that he calls “data recycling.” In lieu of the traditional approach, which involves recruiting new groups of patients and collecting data from scratch, he argues that probing already existing, publicly available data can yield a wealth of insights.

    As he sees it, the “trillion points of data” already in the public sphere could help in repurposing FDA-approved drugs for new diseases, finding better ways to deliver healthcare and more.

    Butte is also principal investigator for the California Initiative to Advance Precision Medicine and ImmPort, a clinical and molecular data repository created by the National Institute of Allergy and Infectious Diseases.

    The gift from Chan, an alumna of the UCSF School of Medicine, and Zuckerberg is funding faculty recruitment and an array of computational work, including the development of UCSF’s Spoke knowledge network, a kind of ‘brain’ for precision medicine that gives researchers access to data from many disparate sources, including laboratory experiments, clinical trials, EHRs and patients’ own digital devices
     

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