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- 04/27/16--13:43: _MACRA proposed rule...
- 04/28/16--06:55: _Landman to take CIO...
- 04/28/16--08:48: _Healthcare industry...
- 04/29/16--07:34: _Buyers' remorse tie...
- 04/29/16--08:23: _GOP Senators issue ...
- 04/29/16--08:54: _Patient portals hel...
- 05/05/16--13:58: _Providers say they'...
- 05/06/16--07:36: _A deep dive on the ...
- 05/09/16--07:08: _HHS Secretary Sylvi...
- 05/09/16--13:18: _Joe Biden to health...
- 05/10/16--07:45: _Telepharmacy softwa...
- 05/10/16--10:32: _MACRA proposed rule...
- 05/11/16--08:06: _Two Missouri hospit...
- 05/12/16--07:07: _Post-acute IT 'gett...
- 05/12/16--08:00: _Ardent Health Servi...
- 05/13/16--06:26: _AHA tells CMS chief...
- 05/16/16--08:04: _McKesson, TriZetto ...
- 05/16/16--10:20: _HIMSS Analytics Res...
- 05/16/16--13:40: _University of Cinci...
- 05/17/16--14:49: _Workflow Technology...
- Quality accounts for half of a total score in year one of the program. Clinicians would choose to report six measures from among a range of options that accommodate differences among specialties and practices.
- Cost accounts for 10 percent of total score in year one. The score would be based on Medicare claims, meaning no reporting requirements for clinicians, HHS points out. This category would use 40 episode-specific measures to account for differences among specialties.
- Advancing Care Information counts for 25 percent of total score in year one. Here, clinicians choose to report customizable measures reflecting their use of technology in day-to-day practice – with a particular emphasis on interoperability and information exchange. HHS emphasizes that, unlike current reporting program, this category would not require all-or-nothing EHR measurement or redundant quality reporting.
- Clinical Practice Improvement Activities count for 15 percent of total score in year one – rewarding clinical practice improvements, such as activities focused on care coordination, beneficiary engagement, and patient safety. Clinicians may select activities that match their practices' goals from a list of more than 90 options.
- 04/28/16--06:55: Landman to take CIO spot at Brigham and Women's
- 62 percent of non-managerial IT staff says was a significantly negative impact on healthcare delivery directly attributable to the EHR replacement initiative;
- 90 percent of nurses indicated the EHR process changes diminished their ability to deliver hands-on care at the same effectiveness, yet only 5 percent of hospital leaders indicated EHR replacement had impacted care in a negative way.
- 04/29/16--08:23: GOP Senators issue draft legislation to 'reboot' meaningful use
- 04/29/16--08:54: Patient portals helping increase revenue, decrease costs
- 05/05/16--13:58: Providers say they're ready to progress to precision medicine
- 05/06/16--07:36: A deep dive on the 'overwhelmingly complex' MACRA proposed rule
- 05/11/16--08:06: Two Missouri hospitals tap Cerner for EHR
- 05/12/16--08:00: Ardent Health Services to implement Epic EHR
- 05/13/16--06:26: AHA tells CMS chief Slavitt how MACRA will impact docs, hospitals
- 05/16/16--10:20: HIMSS Analytics Research: IT Strategy & Value Based Care
- 05/17/16--14:49: Workflow Technology and HIPAA Compliance
The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.
HHS recognizes that physicians are currently buckling under the demands of a "patchwork" of quality- and value-measuring programs such as ACOs, the Comprehensive Primary Care Initiative and the Medicare Shared Savings Program – as well as the Physician Quality Reporting System, the Value Modifier Program and, of course, the Medicare EHR Incentive Program, or meaningful use.
The new proposed rule would streamline aspects of many of those into something called the Quality Payment Program, which includes two paths: the Merit-based Incentive Payment System, or MIPS, and advanced Alternative Payment Models, or APMs.
The majority of Medicare docs will participate, at least at first, in MIPS, according to HHS. That program allows Medicare clinicians to be reimbursed by showing success in four categories: quality, cost, advancing care information, and clinical practice improvement activities. Under the MIPS proposed rule:
CMS would begin measuring performance for doctors and other clinicians through MIPS in 2017, with payments based on those measures beginning in 2019.
As for Advanced Alternative Payment Models, Medicare docs who participate "to a sufficient extent" in various APMs could be exempt from MIPS reporting requirements and qualify for financial bonuses, according to HHS, but the burden to prove that seems high. These models include the recently-unveiled Comprehensive Primary Care Plus (CPC+) model, Next Generation ACOs and others "under which clinicians accept both risk and reward for providing coordinated, high-quality care."
"We’ve developed this program using three principals," said Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services during a conference call Wednesday afternoon.
"First, to be patient-centered to promote our true goal, the highest quality and most coordinated care for beneficiaries," he said. "Second, to be practice-driven, so physicians can select among measures that are right for their practices. And third, consistent with the goals of the legislation to make it as simple as possible for physicians, we have thought about ways to unlock the role of information technology to support physicians. The meaningful use program is being replaced with a simpler program."
Unlocking the full potential of health IT
In a blog-post coauthored by Slavitt with National Coordinator Karen DeSalvo, MD, the officials reemphasized that all these changes impact only Medicare payments to physician offices – not Medicare hospitals or any Medicaid programs.
They did note, however, that CMS and ONC are "already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well."
Meanwhile, they offered some further insight into what the Advancing Care Information component of MIPS would mean for physicians' use of health information technology and the shift away from meaningful use.
Enabling providers to be more "patient-centric, practice-driven and focused on connectivity" is essential, they said, but the existing Medicare meaningful use program for physicians wasn't always helping further that goal.
In contrast, the new MIPS program aims to "support the vision of a simpler, more connected, less burdensome technology."
Advancing Care Information would allow physicians to report on the measures that best reflect how they use IT, simplify the process for achievement by offering multiple means of success and eliminate an all-or-nothing approach to EHR measurement or quality reporting, they said.
In addition, the rule would offer simplifications such as reducing reporting to a single public health immunization registry, exempting certain physicians from reporting "when EHR technology is less applicable to their practice" and allowing physicians to report as a group.
The proposed MIPS rule also focuses on "an all-time low of 11 measures" according to the post, and no longer requires docs to report on clinical decision support or computerized provider order entry.
The program would be aligned with ONC's 2015 Edition Health IT Certification Criteria, with an emphasis on interoperability, health information exchange, security measures and patient access.
With newly-certified technology required to use APIs, the rule would broaden the connectivity options open to physicians, enabling them to make wider use of apps, analytics tools and other consumer devices.
By ensuring health IT is "more open and plug-and-play," the aim was to "put the power back in the hands of physicians," said Slavitt on Wednesday's conference call. "We have designed a powerful program that is much easier to use, lower-burden and that promotes connectivity and innovative technology."
Healthcare IT News Managing Editor Bill Siwicki contributed to this story.
Adam Landman, MD, will take the reins as chief information officer at Boston's Brigham and Women's Health Care, effective May 2.
Landman, a physician in the Department of Emergency Medicine serves as BWHC's chief medical information officer for health information innovation and integration.
As CIO, he succeeds Cedric Priebe, MD, who served as CIO from January 2014 through September 2015. Priebe took a position as senior vice president and chief information officer of Lifespan in Rhode Island.
As BWHC's CIO, Landman will be responsible for developing system-wide strategic IT initiatives. He is charged with creating the next generation of information systems within BWHC.
"Adam is the best possible leader to assume this role," said Betsy Nabel, MD, president of BWHC, in a statement. "He has been ably overseeing a range of Partners eCare/Epic implementation and optimization responsibilities and is experienced in designing early-stage technology innovation."
Nabel added that Landman would continue to provide leadership on the innovation front at Brigham.
Landman received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. He trained in emergency medicine at UCLA Medical Center, and he is board certified in emergency medicine and clinical informatics.
He received his master's degree in health sciences at Yale University and completed graduate degrees in information systems and healthcare policy and management at Carnegie Mellon University
On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades."
The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies.
"By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients."
So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians.
In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule.
"We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements."
American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians."
In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens."
American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'"
The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs.
CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc.
"Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs.
"We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs.
"As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government."
Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in.
— Joy Rios (@askjoyrios) April 28, 2016
— Harold Smith III (@haroldsmith3rd) April 28, 2016
1/Bottom Line #MACRA NPRM
Game changer. Lots of great changes, 100's of thoughtful details and decisions.
Biggest blind spot can be fixed
— Farzad Mostashari (@Farzad_MD) April 27, 2016
Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX
— Andy Slavitt (@ASlavitt) April 27, 2016
— Amanda Narod (@AmandaBinDC) April 28, 2016
Four years after what Black Book calls the "replacement frenzy," a recent survey from the market research firm indicates that 87 percent of financially struggling hospitals now regret changing their EHR systems.
Among the difficulties the survey highlighted were higher than expected costs, layoffs, declining inpatient revenues, disenfranchised clinicians and doubts over the benefits of switching systems.
The survey, which polled 1,204 hospital executives and 2,133 IT staff users, found that 14 percent of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn't support the total cost of their replacement EHR.
"It was a risky decision as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years," said Doug Brown, managing partner of Black Book, in a statement.
"No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues," he said.
Other key findings Black Book gleaned from its survey:
"In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care," Brown noted.
Black Book also found that hospital EHR replacements cost jobs, and levels of interoperability decreased. Also, EHR sales people exaggerated the automatic buy-in of physicians and other clinicians, according to Black Book findings.
A group of Republican senators who have been looking to "reboot" meaningful us since 2013 released new draft legislation this week they say aims to make the incentive program work better for providers and taxpayers.
U.S. Senators John Thune, R-South Dakota, Lamar Alexander, R-Tennessee, Mike Enzi, R-Wyoming, Pat Roberts, R-Kansas, Richard Burr, R-North Carolina and Bill Cassidy, R-Louisiana – all of whom voted against the 2009 ARRA law that helped establish meaningful use through the HITECH Act – wrote this week to HHS Secretary Sylvia Burwell and CMS Acting Administrator Andy Slavitt, looking for feedback on the bill.
The draft legislation would shorten the reporting period for eligible physicians and hospitals from 365 days to 90 days, which would give providers more time to implement EHR systems, relax the all-or-nothing nature of the current program requirement, and extend the ability for eligible providers and hospitals to apply for a hardship exemption from the meaningful use requirements.
"These policies seek to provide CMS with the tools and guidance necessary to advance the use of EHRs as part of utilizing health IT to the benefit of patients in a manner that protects the significant taxpayer investment in our nation’s health care system," the legislators write.
Thune, Alexander, Enzi, Roberts, and Burr are original members of the Senate’s health IT working group, known as Re-examining the Strategies Needed to Successfully Adopt Health IT, or REBOOT.
Back in 2013, they published a white paper outlining their complaints about lack of momentum toward interoperability, patient privacy concerns, EHRs' potential to enable fraud and abuse and other concerns about federal health IT policy.
"We received critical feedback in response to our 2013 report which has informed our work on these issues," the senators wrote to Burwell and Slavitt this week. "We also engaged with stakeholders including health IT developers, providers, and patient-focused organizations to assess their experiences with the meaningful use program, as well as their concerns with the state of health IT, specifically EHRs, over the years.
"In response to this feedback we have identified a few key policy changes outlined in the enclosed draft legislation, and we respectfully request feedback as part of our continued constructive dialogue on these issues."
Michael Middleton, MD, credits online patient portals with helping him grow his Orlando, Florida-based pediatric practice more than three-fold in two-and-a-half years – while keeping staff cost increases at 20 percent.
"The primary way it's benefited us financially is by not forcing us to hire more admins as our practice has grown," he said. "The efficiency comes with instantly directing the right message to the right person. The other part is accountability; things are written down not verbalized."
Indeed, patient portals can offer financial benefits that improve collections, reduce staff workload and help drive engaged patients with better health outcomes.
Lesley Kadlec, director of health information management practice excellence at American Health Information Management Association, says portals "automate and streamline many processes that previously required staff time, such as setting up appointments, requesting prescription refills, asking and answering questions and providing account and billing information.
"Beyond administrative tasks, portals can distribute educational resources and targeted information to the appropriate audience," she said.
Middleton, who uses online portals to triage non-emergent patient questions, says "previously, we'd schedule an appointment, be in a room together. They'd verbalize, I'd type and then get to the therapeutic part of the visit."
Now, on the other hand, "we start the appointment at the mid-point. It's much more efficient, not to mention details are relayed more thoroughly," he says.
According to a report from athenahealth, which develops patient portals of its own, such triaging enabled one practice to contain physician email responses to about 20 percent of patient inquiries.
Use of secure email allowed physicians respond to patients at their convenience and view "inquiries in the context of the full patient record, which they may not have at hand when patients call," according to the report. "All of these can improve provider productivity, which, in turn, can improve practice finances."
Portals also let patients receive electronic statements and pay their bills online. Summit Medical Group, a 500-physician group in Berkeley Heights, New Jersey, receives 30 percent of its patient payments via online portals, according to the report.
Middleton, for his part, says about 7 percent of payments come through the portal. He hopes that will increase as the convenience makes it "easier for families to sign up and utilize" the online tool.
"Initially, one of the obstacles we had was patients weren't linked by families," he said. "If a patient had four kids, they'd have four portal accounts. Sign-up and sign-on has become much easier. There's a great mobile app for our patients."
Josh Gray, vice president, athenaResearch, says online access translates into financial rewards: "When clients increase portal adoption by 20 percent or more, they see improvements in patient pay yields of four to eight percent.
"They get paid more and faster," he said. "If you can get a patient on a portal, they're 13 percent more likely to return. The value of the patient who returns is eight to 20 percent higher."
The athenahealth report echoes this point, noting that patients, who return to a practice at least once generate more than $800 in ambulatory practice collections over three years, versus $147 for those who don't.
Kadlec describes consumer engagement "a high priority" for healthcare today, and one "likely to increase as health information technologies, like portals, continue to evolve." She adds that, "as healthcare delivery moves toward value-based reimbursement, patient care and consumer engagement are becoming increasingly intertwined."
Patients "expect to have insight into their care and demand value for their healthcare dollar, particularly in an environment where healthcare costs are rising and reimbursement is decreasing," she said. "Patient portals are becoming a technological catalyst that allow patients to interact and communicate with their healthcare providers in a 24/7 environment."
Two-thirds of healthcare organizations believe personalized medicine is already having a measurable effect on patient outcomes, according to a new survey. Even more, 75 percent, say it will impact their organizations over the next two years.
Meanwhile, 92 percent of respondents said in five years their hospital will no longer be focused on traditional approaches to care, according to the survey, from Oxford Economics and SAP, which polled 120 healthcare professionals in Europe and North America.
"Personalized medicine offers better and more efficient ways to address a wide range of challenging medical issues," said Edward Cone, deputy director of thought leadership and technology practice lead at Oxford Economics, in a statement.
"At the same time," he said. "There remains a lot of work to be done on the details of governance, culture, and information technology."
Precision Medicine has seen a major push in the past few years, including the highly-visible $215 million Precision Medicine Initiative announced by the Obama administration last year. However, to be able to reap the benefits of this new paradigm, there are a few crucial challenges that need to be addressed.
The right tools are imperative to supporting the shift into more personalized care. More than 70 percent of survey respondents said big data capture and storage were necessary to the success of personalized medicine, while another 65 percent called for an increase in the use of predictive analytics.
While barriers are prevalent, many healthcare leaders are beginning to change policies needed to support precision medicine: 64 percent have created new privacy policies, and 60 percent have increased security measures to safeguard patient data.
And almost half of the respondents are working toward changing institutional culture to reflect some of these privacy and security challenges.
"Personalized medicine leverages broad data sets including clinical data and genomics to move beyond the one-size-fits-all model into more individualized care," said David Delaney, MD, chief medical officer at SAP, in a statement.
"To reach the full potential of personalized medicine, however, industry stakeholders must take definitive steps to invest in advanced technologies and workforce talent," he added. They should also "adjust to new governance models and accept significant cultural shifts around data sharing and standards that foster easy interoperability of information."
As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA notice of proposed rule-making so that you will not have to.
Although this post is long, it is better than the 20 hours of reading I had to do!
Here is everything you need to know from an IT perspective about the MACRA NPRM.
1. What is the MACRA NPRM trying to achieve with regard to healthcare IT?
The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System, the Physician Value-based Payment Modifier and the Medicare Electronic Health Record Incentive Program for eligible professionals, creating a single set of reporting requirements. The rule would sunset payment adjustments under the current PQRS, VM and the Medicare EHR Incentive Program for eligible professionals.
2. Who is affected?
In the MACRA NPRM, the word Eligible Professional is replaced with the term Eligible Clinician, expanding the population of individuals covered by Merit-based Incentive Payment Programs. MIPS eligible clinicians will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and groups that include such clinicians. Hospitals are not affected by this rule and hospital-based MIPS eligible clinicians are not required to participate in the information technology portions of MACRA, since they may not have direct control over the software implemented by the hospital.
3. When does the rule take effect?
The rule proposes that the first performance period would start in 2017 for payments adjusted in 2019. It’s not exactly a stimulus program - some clinicians will see reduced payments for non-performance and some will see enhanced payments for exemplary performance - a zero sum redistribution of payments.
4. Does meaningful use and electronic clinical quality measure reporting go away?
MACRA’s enactment altered the EHR Incentive Programs such that the existing Medicare payment adjustment for a eligible professionals ends after calendar year 2018. Generally, MACRA did not change hospital participation in the Medicare EHR Incentive Program or participation for professionals in the Medicaid EHR Incentive Program.
Meaningful Use of certified EHR technology is renamed to “advancing care information” and the criteria are streamlined - removing the CPOE and Clinical Decision Support requirements. In 2017, clinicians may still use 2014 edition certified technology and report on eight Stage 2 measures. By 2018, clinicians need to use 2015 edition certified technology and report on six Stage 3 measures, described below.
Quality measures will be selected annually through a call for quality measures process.
5. What is the role of ONC and Certification?
On March 2, 2016, ONC published the ONC Health IT Certification Program: Enhanced Oversight and Accountability proposed rule, which would expand ONC’s role to strengthen oversight, requiring that clinicians give access to their EHR for “field inspection” of functionality by ONC.
The MACRA NPRM proposes that clinicians must attest they have cooperated with ONC surveillance and oversight activities. Further, they must attest they have not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified EHR technology.
6. What are the MACRA advancing care information objectives and measures that have replaced Meaningful Use?
The six criteria which are required as of calendar year 2018 are
1. Protect Patient Health Information - Security Risk Analysis
2. Electronic Prescribing
3. Patient Electronic Access - Patient Access, Patient-specific education
4. Coordination of Care through Patient Engagement - View/Download/Transmit, Secure Messaging, Patient Generated Health Data
5. Health Information Exchange - Patient Care Record Exchange, Request/Accept Patient Care Record, Clinical Information Reconciliation
6. Public Health and Clinical Data Registry Reporting - Immunization Registry Reporting
Here are examples of the actual measurements:
Secure Messaging Measure: For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of certified EHR technology to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative).
View, Download, Transmit Measure: During the performance period, at least one unique patient (or patient-authorized representatives) seen by the MIPS eligible clinician actively engages with the EHR made accessible by the MIPS eligible clinician. An MIPS eligible clinician may meet the measure by either—(1) view, download or transmit to a third party their health information; or (2) access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the MIPS eligible clinician’s certified EHR technology; or (3) a combination of (1) and (2).
7. So what must a clinician do and when?
For the period January 1, 2017 to December 31, 2017 (yes, it’s a full year, not 90 days), clinicians must
a. Use a 2014 or 2015 Edition Certified EHR
b. Report on either eight stage 2 or six stage 3 advancing care information objectives and measures:
c. Attest to their cooperation in good faith with the surveillance and ONC direct review of their EHR
d. Attest to their support for health information exchange and the prevention of information blocking.
e. Continue to practice medicine
Sorry, e. was an attempt at humor. Listening to each patient’s story, being empathic and healing are optional. After spending 20 hours reading the MACRA NPRM, I had one overwhelming thought. Sometimes when you remodel a house, there is a point when additional improvements are impossible and you need to start again with a new structure. The 962 pages of MACRA are so overwhelmingly complex, that no mere human will be able to understand them. Above, I have only covered the HIT related concepts, which are a small subset of all the changes to payment processes. This may sound cynical, but there are probably only two rational choices for clinicians going forward - become a salaried employee delivering clinical care or become a hospital-based clinician exempted from the madness.
The folks at CMS are very smart and well meaning, but it’s hard for me to imagine implementing the NPRM as written in the timeframes suggested. I will watch closely for comments from organizations such as the AMA, AHA and clinician practices. I’m guessing that many will see the ONC Surveillance provisions as overly intrusive and the "advancing care information" requirements as creating more burden without enhancing workflow. Maybe the upcoming presidential transition (whoever is elected) will give us time to pause and reflect on what we’ve done to ourselves. As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.
Health and Human Services Secretary Sylvia Burwell said the department is committed to an open, connected health system, and is focusing on three areas to bring that about: data blocking, interoperability and security.
“We all want a health system where information flows seamlessly and securely when and where you need it most,” Sylvia Mathews Burwell said last week at the American College of Physicians. “When you have all the information you need, you can see the whole health picture.”
To enable that, HHS is trying to change the culture “so doctors and hospitals understand that patients have a right to their records, data blocking is not tolerated, and providers share data with others caring for their patients,” Burwell said.
Eliminating data blocking is also a step toward enabling more information interoperability wherein “health IT systems are speaking the same language through common standards so they can communicate with one another,” Burwell said, noting that in the last six years the industry has tripled its adoption of electronic health records but considerable work remains.
And as patient and medical data flows more effectively, Burwell said HHS is also girding to protect it via rules and regulations designed with the idea that interoperability is vital to market success in mind.
“Whether it’s helping doctors make more informed decisions, giving people the tools to be active partners in their own health, or advancing our understanding of quality, better use of data moves our whole system forward,” Burwell said at the ACP. “That’s why it is so important that hospitals and physicians stand up against data blocking.”
HHS has been working on interoperability and data blocking for some time now and in early March most electronic health records vendors signed a pledge to not block data and also support standardized APIs to make information sharing easier, a move Burwell said at HIMSS16 was “a critical first step.”
For Vice President Joe Biden, his National Cancer Moonshot Initiative is more than just a government program – it's personal.
When his son Beau was fighting cancer, getting his different hospitals to share information was incredibly difficult, Biden said Monday at Health Datapalooza in Washington. If the Vice President of the United States struggles to get access to information, he said, how difficult is it for those patients who don't have that sort of sway?
"This matters," said Biden. "It's a matter of life and death."
Biden took to the stage at Health Datapalooza not just to share his own experiences, but to put out a call to action: While the government has taken great strides to increase access to technology-enabled healthcare, it's still not enough, he said.
More hospitals, researchers, scientists and providers need to "open access to their data to prevent cancer," said Biden.
"We have to ask ourselves, why are we not progressing more rapidly?" he said. "While our government can do a great deal, this is not the work of the government alone. We all have to work together to make progress.
"Big data and computer power together provide the possibility of significant insight to what can trigger cancer," he added. "In order for this promise to be realized, we first need to generate enough data to qualify as big data."
Secondly, data needs to be more readily shared, Biden said. One of the biggest barriers to progress is different technology platforms can't talk to each other, while this is the information that will help providers make more accurate assessments. Additionally, all of those involved in healthcare must be willing to share this data in a safe and effective matter.
"We need to break down silos that keep research away from the world," Biden said. "Researchers aren't incentivized to share data, but they need to share data to find results more rapidly.
"You've developed this technology," he added. "And we need to use these same talents in the fight against cancer. To do this we have to build a network around the patient. We need you. We need your talents, your drive and your passion."
Biden asked all of those in attendance to visit Whitehouse.gov/CancerMoonshot to join the fight against cancer and provide insight to help shape the moonshot into a more effective initiative.
"I desperately need your input," he added. "Everyday thousands of people are dying and millions more are desperately looking for hope. That's why I'm asking individuals and organizations to join us as a part of this cancer moonshot. Tell me about your plans and solutions to overcome these barriers. Help in the fight against cancer."
Getting pharmacists involved in patient-centric activities, including being part of clinical care teams, is a little easier thanks to telepharmacy technology.
When Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, needed to optimize its pharmacy workflow with the goal of improving patient care, it turned to PowergridRx, a cloud-based HIPAA–compliant telepharmacy platform from San Francisco-based PipelineRx.
Starting in February, Dartmouth-Hitchcock began deploying PowerGridRx in its hospitals across New England.
PowerGridRx is a software as a service platform that aggregates, manages and optimizes virtual pharmacy management for health systems. In addition, it differentiates Dartmouth-Hitchcock's telepharmacy network and manages the order verification process for current and future facilities.
The interoperable technology platform is designed to improve medication administration visibility between facilities and addresses logistical and budgetary challenges that arise from managing and staffing multiple care settings.
Sarah Pletcher, MD, medical director and founder, Center for Telehealth at Dartmouth-Hitchcock Medical Center, said the health system uses PowerGrid Rx as a tool in the delivery of telepharmacy services across wider landscape.
"Our customers are the ultimate end user in that regard," Pletcher said.
After going live in six hospitals Dartmouth-Hitchcock has processed thousands of patient orders: "We have data that suggests the benefit to the hospitals in that we are allowing them to load-level staffing and optimize their in hospital team sometimes deploying them to more patient care or clinical activities," she said.
Pletcher pointed out that for many smaller rural and critical access hospitals, the volumes that they see on weekends for example, aren't enough to rationalize them having an in-house pharmacist.
"But we are also finding hospitals recognizing the value of having telepharmacy support for scenarios where they want to allow their pharmacists to be out on the floors helping with patient care," she said.
In a cancer infusion suite for instance, Pletcher explained that oftentimes pharmacists are part of clinical team working on projects where they might be involved in an electronic medical record implementation, or working on quality or formulary projects for the hospital.
"Any time we can help extend their team to allow them to optimize their in-hospital team, we're happy to be there for them," she said.
From a technology perspective, Pletcher noted that there are obstacles associated with integration and with host IT systems and EMRs.
She said that with anything involving multiple hospital IT departments and multiple hospital EMRs, there's always a challenge – not just the technology integration, but cultural barriers where hospitals have different levels of comfort for how much bi-directional integration they want with outside software platforms.
"Because we offer so many other telemedicine services this is something we are familiar with managing – the telepharmacy is the latest service – we have six or seven other 24/7 telemedicine services to hospitals where we've had to contend with IT or EMR integration. We kind of know to expect and support those conversations."
Pletcher said Dartmouth-Hitchcock is expanding its telepharmacy program to more sites and more regions. "We're excited about the opportunity to further integrate our telepharmacy solutions with other clinical services."
Industry insiders contend that the demand for PowerGrid Rx-type technology is on the rise for multi-site multi-facility organizations that are growing and want to tie their pharmacy network closer and closer together.
"We want to create a platform that enables them to share pharmacy labor and pharmacy resources across their whole organization, opposed to having to staff individually each hospital within their network, this enables them to tie them to together," said Brian Roberts, CEO of PipelineRx.
Roberts noted that among the challenges is to work with different and multiple types of IT systems.
"Some of our customers have eight to ten different types of IT systems that they work with - we integrate back with their host IT systems and bring it into one platform."
The other side, according to Roberts, is that they want a system that can capture policies and procedures for each one of their individual hospitals. So for example, if they were creating a central telepharmacy center they would want that telepharmacist to have information at their fingertips.
"Our tool helps consolidate and bring policies and procedures into one software offering," said Roberts who added that because PowerGrid Rx is a cloud-based piece of software – there is no hardware on each individual site.
"So we use the power of the Internet to build a private cloud that can manage all that information – manage the information and store the information for the hospitals."
Roberts said CIOs like that because it’s a cloud-based piece of software that doesn't require them to have to go and do updates and update hardware; that's all taken care of from the PipelineRx side.
Many physicians have waited with bated breath for the end of meaningful use, looking forward to a new era of less burdensome compliance requirements and more realistic reporting guidelines.
But after closely reading the Centers for Medicare and Medicaid Services' thousand-page proposed rule for the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA – which would sunset meaningful use for Medicare physicians – it seems many providers are realizing it's not quite the fix they had in mind.
While it's apparent CMS had "good intentions" when it crafted the proposed ruling, there are a lot of things the agency failed to consider, John Goodson, MD, staff internist at Massachusetts General Hospital and associate professor at Harvard Medical School told Healthcare IT News.
"What's happening with MACRA is transformational: It's the biggest thing since the Resource-based relative value scale," Goodson said.
But just as "CMS didn’t consider how RBRVS - could tank providers," the results of which are playing out right now, he said, the agency may have missed its mark here too. RBRVS stands for resource-based relative value scale.
According to John Squire, president and chief operating officer of Amazing Charts, a developer of ambulatory EHRs and practice management tools, there are two potential victims if the ruling is passed as is: small practices and Medicare beneficiaries.
"By basing penalties on outcomes, you may be ranking some of these physicians on circumstances out of their control," Squire said. "There are behavioral things a physician can't control. And it doesn’t allow for any exemptions, outside of low-volume."
MACRA also removes the option for providers to opt-out of reporting by paying a penalty, which means all providers who accept Medicare patients must comply.
Many small practices won't be able to keep up, he said. And according to Goodson, "Providers are being put in a position where it's unattainable."
"One unintended consequence, which happened with meaningful use, is some will look at the list of requirements and feel inundated," said Squire. "They'll just say, 'The heck with it; I'll just stop accepting Medicare patients or require cash-only.'"
Furthermore, the rule sets a very high barrier for practices hoping their existing participation in accountable care organizations counts for the Alternative Payment Model path, rather than requiring them to attest for the Merit-Based Incentive Payment System, or MIPS.
Squire said, "Providers who have already bought into ACOs are crying foul: 'I've designated resources to it and you're saying that it doesn’t matter.'"
While Goodson recognizes CMS has a difficult task in responding to the pushback from the industry, he also recognizes that healthcare is "embarking on a whole new set of complications and implications.
"Quality is really focused around recording, but another piece is built around data interchange," Squire said. "Physicians need to weigh how their systems support MACRA – and let the technology do the work to relieve the burden for the provider. It's your practice methodology that would need to adjust."
"A lot of people think this is going to be a whole new system," said Goodson. "But it's just a modification of the current system. This is a new complicated set of recording needs."
Two southeast Missouri healthcare organizations – SoutheastHEALTH, in Cape Giradeau, and Missouri Delta Medical Center, in Sikeston – will each install a Cerner Millennium EHR system.
The platform provides an integrated digital record of a patient's health history, including clinical and financial data. Also, by using the online patient portal, patients will be able to securely message their physicians, schedule appointments and access their health history.
"SoutheastHEALTH prides itself on being a high-tech, high-touch hospital focused on making a positive impact, and the EHR will help fulfill that mission," said Ken Bateman, president and CEO of SoutheastHEALTH, in a statement.
Besides transitioning to Millennium, Missouri Delta Medical Center will also deploy Cerner's CommunityWorks technology, a prescriptive and remote-hosted IT platform tailored to support community healthcare organizations that provide care to rural communities.
More than half of Cerner clients that are live with the CommunityWorks model have achieved Stage 6 of the HIMSS Electronic Medical Record Adoption Model.
"As a rural community hospital, we have been recognized with top performing patient satisfaction scores and clinical process of care measures," said Jason Schrumpf, president and CEO of Missouri Delta Medical Center, in a statement.
Both organizations expect to benefit from advanced interoperability capabilities, which will enable the transfer of patient data between the organizations and among health systems across the country.
After years of dwelling in the shadows of healthcare, the long-term and post-acute care industry may finally be ready to join its hospital colleagues in the IT spotlight.
The path is long and steep, but operators of skilled nursing, outpatient rehabilitation, assisted living, memory care, hospice and home care agencies are embracing their important new roles as providers in the dynamic post-acute care environment.
When the Office of the National Coordinator put together the electronic health record and interoperability initiative in 2004, long-term care got nary a mention; and as recently as 2009, LTC providers got left out of the multi-billion dollar incentive from the American Recovery and Rehabilitation Act because designers didn't consider their relevance for the program.
How times have changed in just a short period of time. With the advent of accountable care organizations, post-acute care provider networks and the move toward population health, suddenly long-term care facilities have gained prominence as valuable components in the equation.
But while they now have a higher profile, long-term care operators are also coming to terms with the fact that they are still largely dependent on manual processes and that they are woefully deficient in IT personnel. In essence, this new role comes with the huge responsibility of joining the digital revolution.
"It's getting interesting," said LaDonna Sweeten, managing director with Chicago-based Huron Healthcare's technology consulting practice. "You can understand how some post-acute care providers were forgotten in federal initiatives. But now we're seeing them organize and have a stronger voice, with implications on the acute care side."
As the ACO movement gains momentum, providers in both acute and post-acute sectors are looking for enhanced dialogue, Sweeten said, because "they realize they aren't separate pieces of care anymore."
For post-acute care, it means a serious focus on adopting EHRs and understanding the machinations of analytics and interoperability. Some of the actual data on interoperability has been tackled with standards like HL7, but other areas like care plans, clinical documentation and care pathways still need to be addressed, Sweeten said.
Those processes will require collaboration between the sectors and while that has yet to be done, she believes it will as the population health model takes hold.
"Vendors are looking at software for post-acute providers and it is very specialized," she said. "One of the biggest issues is with the continuum – if we have an acute care patient with a follow-up plan to transition into skilled nursing or senior living, there are duplications of effort because the sectors are different. These processes must be combined to avoid duplication. We have done a lot with hospitals on the acute care side and we need to make the same progress as we connect acute and post-acute. There isn't a pathway yet."
Hal Tierney, director of technology for Boston-based Sapient, says a major EHR obstacle for long-term care operators is the lack of full clinical information system enterprises required to populate an EHR.
"The lack of clinical information systems, such as laboratory, pharmacy and radiology reduce the capability of the EHRs to provide clinical or diagnostic value," he said.
A 2013 report by the U.S. Commission on Long-Term Care estimates that the number of people who are dependent on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050. Analytics will be a critical function to support the treatment and tracking of these patients from patient care and operational standpoints, notes Adrianna Iorillo, vice president of professional services for Jacksonville, Fla.-based CSI Healthcare IT.
Analytics are the key to improving communications between acute and post-acute entities, which lead to better patient outcomes, Iorillo says.
"Long-term care facilities can find improved patient satisfaction from better response times in medication and pain management, while improved methods to document provider and caregiver notes will help patients stay engaged in their well-being," she said.
"Overall, better outcomes from the patient can help reduce the need for admissions or readmits to hospitals and the increased communication tools available can decrease the number of cases of depression and isolation that are sadly common in nursing home settings."
[Also: Post-acute HIEs make strides]
Long-term care operators should move to accelerate their adoption of analytics systems to maximize their accessibility to all data relevant to the treatment history of their patients, and to maximize the acquisition and retention of data as part of the continuing provision of care, Tierny said.
"When combined, this data can underpin retrospective and prospective data analysis pertaining to patient specific care milestone events, trends and adherences," he said.
"Operators need to understand that the information captured across the continuum of care has the most opportunity as a resource for the provision of healthcare to their patients.
Analytics done well can move long-term care operators from 'reactive' operations and decision making, to 'proactive' modes of operations."
Iorillo adds that "technology and analytics have a compounding affect over time – easier and secure methods for a provider to communicate immediately with other care providers can only improve care."
HME at last
Alongside the long-term care industry, home medical equipment providers have also brought up the rear when it comes to technology adoption. Both sectors have shared similar challenges when it comes to maintaining cash flow, overcoming constant reimbursement cuts and finding the funds to deploy IT in a way that benefits them.
For HME providers, technology strength lies within their billing systems, which in recent years have grown from strictly conducting business transactions to controlling multiple aspects of the business. One such system is CommandCenter, a business process management platform from Suffern, New York-based Medforce.
"Business process management can act as a backbone for an entire organization, gathering data and connecting to disparate business applications from intake to order management," said Medforce CEO Esther Apter.
"It creates comprehensive reporting that provides predictive analytics and actionable insights. You can look at not just top line numbers, but actual productivity throughout the organization to identify bottlenecks, duplication of effort, wasted effort and other opportunities for process refinement."
By centralizing business analysis, HME providers are able to create accountability and present cogent operational data – a distinct advantage in the competitive ACO marketplace, Apter said.
Nashville-based Ardent Health Services plans to unite all its hospitals and physician groups on an Epic Systems EHR platform.
The move, Ardent officials note in an announcement on its website, will offer caregivers with a single, stronger patient information system to help streamline their work. The main goal is to give caregivers more time at the bedside to boost care quality and patient outcomes.
"This investment is a significant step in our journey to deliver high-quality clinical care and exceptional customer service more efficiently," said David T. Vandewater, president and CEO of Ardent Health Services in a statement. The estimated cost of the project is $150 million.
Nearly 500 Ardent team members, including physicians, bedside nurses, registration and discharge staff representing each part of the care continuum and all specialties participated in the demonstrations and assessment, Vandewater added.
Ardent will replace 80 information systems currently in use across its facilities with the Epic platform. The goal is to increase efficiencies by streamlining services such as registration, billing, clinical applications and population health initiatives.
Ardent will become the first investor-owned hospital company to use Epic throughout the entire organization, which includes BSA Health System in Amarillo, Texas; Hillcrest HealthCare System in Tulsa, Oklahoma; and Lovelace Health System, in Albuquerque, New Mexico. They include 14 hospitals and three multi-specialty physician groups.
Epic staffers will begin working alongside Ardent employees this summer to build the software system, a process that typically takes nine to 10 months. The first Ardent health system is due to transition to Epic in the fall of 2017 and the others are scheduled to follow each quarter.
As part of the deal, Ardent will also deploy Epic's MyChart software, a portal that enables patients to find personal and family health information online. Patients will be able to message doctors, attend e-visits, complete questionnaires and schedule appointments.
Implementation of MACRA will impact not only physicians, but also the hospitals with whom they partner, the American Hospital Association told Andy Slavitt, acting administrator of CMS, and the U.S. House Ways and Means Subcommittee on Health on Wednesday.
Health Subcommittee members met with Slavitt Wednesday on the implementation of the Medicare Access and the CHIP Reauthorization Act of 2015.
MACRA's Quality Payment Program, released by CMS on April 27, consolidates a patchwork of programs into two paths for physicians receiving Medicare payments: the Merit-based Incentive Payment Systems (MIPS); and an Advanced Alternative Payment Model (APM).
The AHA said it applauds MACRA's streamlining of the physician reporting burden, but still has concerns, especially for smaller practices, and is disappointed the federal government is providing no financial incentives for upfront investments in technology to meet the demands of implementation.
The estimated investment is $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, the AHA said.
"Hospitals that employ physicians directly may bear the cost of implementation of an ongoing compliance with the new physician performance reporting requirements under the Merit-based Incentive Payment Systems, as well as be at risk for any payment adjustments," the AHA said in a statement. "Moreover, hospitals may be called upon to participate in alternative payment models so that the physicians with whom they partner can qualify for bonus payments and exemption from MIPS reporting requirements that accompanies the APM 'track.'"
House Ways and Means Subcommittee on Health Chairman Pat Tiberi, R-Ohio, asked Slavitt about concerns he's heard about the difficulty smaller practices may have coming into compliance, saying the rural provider, and one or two-person provider group "has a bunch of angst right now."
Slavitt said the data shows that smaller and solo practices can succeed as well as physicians in larger-size groups as long as they report. It's up to CMS to make the reporting burden as easy as possible, Slavitt said.
"Importantly we are looking for additional steps and ideas as people review the rules, but I will say that we are focusing on technical assistance, providing access to medical home models, opportunities to report in groups and using a reporting process that automatically feeds data, reduces the number of measures and overall lowers the burden for small practices," Slavitt said.
Small physicians can report in groups and other physicians may not have to report at all because they're under a minimum threshold for the number of Medicare patients they see, Slavitt said.
Slavitt said he's heard from physicians that they want to focus on care, not reporting.
Congress has provided funding for MACRA technical assistance to small practices, rural practices and others, he said.
MACRA replaces the sustainable growth rate and changes the way physicians and providers are paid, moving the healthcare system closer to CMS's goal of tying 50 percent of Medicare payments to alternative payment models by 2018.
CMS is taking comment on the MACRA proposal for 60 days.
"Success will come from adopting approaches that are practice-driven," Slavitt said. "It is our intent to align the MIPS and the Advanced APM components of the Quality Payment Program, allowing maximum flexibility for clinicians to switch between MIPS and participation in Advanced APMS based on what works best for them and their patients."
To spur motivation, MACRA established an 11-member independent advisory committee, the Physician-Focused Payment Model Technical Advisory Committee, PTAC, that will meet quarterly to review payment models.
The AHA has formed its own clinical advisory group to identify important policy and operational implications of MIPS and APMS for hospitals.
The AHA recommends hospital-based physicians be able to use their hospital's quality reporting and pay-for-performance program to measure performance in MIPS; employ risk adjustment rigorously, including for sociodemographics to ensure providers do not perform poorly simply because they care for more complex patients; and align EHR Incentive Program changes for physicians with those of eligible hospitals.
The AHA applauded CMS's proposal to reduce the number of measures for quality reporting from nine to six, and also for its recent work with private insurers and physician groups to reach agreement on a common set of physician quality measures that can be used in both CMS and private payer pay-for-performance programs.
"Physicians and hospitals alike spend significant resources reporting on multiple versions of measures assessing the same aspect of care to meet the differing requirements of CMS and individual private payers," the AHA said.
The AHA is disappointed CMS has proposed a narrow definition of financial risk in advanced APMs for purposes of MACRA bonus payments, in not recognizing the upfront investment made by providers to implement alternative payment models.
The AHA also said fraud and abuse laws need to be modified for a "legal safe zone" where physicians and hospitals can share information
In a move meant to help payers simplify the management of complex reimbursement rules, McKesson and Cognizant subsidiary TriZetto are partnering to integrate McKesson's ClaimsXten and ClaimsXten Select clinically-based claims auditing tools with TriZetto's QNXT enterprise core claim administration technology.
Regulatory and competitive pressures are forcing payers to work toward improved efficiencies and better customer experience. By combining the two platforms, McKesson and TriZetto will be able to help health plans automate payment and medical policy, simplify management of complex clinical and reimbursement rules, the companies said.
"This new integration will help health plans boost auto-adjudication rates, minimize manual effort and take advantage of industry-leading clinically sourced content to provide timely and consistent reimbursement of claims," said Alan Stein, senior vice president, payer product management for TriZetto.
Officials note that "stringent certification process" derived from the McKesson and Trizetto's previous integrations will help ensure the reliability of the interfaces between ClaimsXten and QNXT systems.
"Building on our past success developing interfaces between McKesson ClaimsXten and and TriZetto Facets, this integration with QNXT will help ensure smooth transitions – especially from McKesson ClaimCheck to ClaimsXten Select – and a viable growth path for health plans challenged with scaling mixed fee-for-service and value-based models to operational levels," said Carolyn Wukitch, senior vice president of McKesson Health Solutions.
To better understand how value-based purchasing is influencing hospital IT decision-making, executives from health systems, hospitals, and clinics were surveyed. Research Findings: Clinical Communication Strategy Is Key to Supporting Value-Based Care
UC Health – the flagship University of Cincinnati Medical Center, as well as 167 of its affiliated practices – has reached the Stage 7 on the HIMSS Analytics EMR Adoption Model.
HIMSS Analytics developed the EMRAM in 2005. Its eight stages (0-7) track a hospital’s implementation and use of health IT applications. In 2011, it launched the ambulatory model, meant to evaluate the progress and impact of EMRs for ambulatory facilities – physician practices, outpatient centers and specialty clinics – owned by hospitals in the HIMSS Analytics Database.
Only 4.2 percent of more than 5,400 U.S. hospitals in HIMSS Analytics' database have attained Stage 7; just 7.9 percent of more than 34,000 ambulatory clinics have scored a Stage 7 Ambulatory Award.
UC Health, the University of Cincinnati’s affiliated health system is the region’s only academic health system. It includes University of Cincinnati Medical Center, three additional hospitals, and the University of Cincinnati Physicians, Cincinnati’s largest multi-specialty practice group with more than 700 board-certified clinicians and surgeons.
John H. Daniels, global vice president of HIMSS Analytics' healthcare advisory services group, said UC Health "has gone above and beyond the EMRAM Stage 7 criteria. They have already extended the closed-loop medication administration process to their infusion clinic and for interventional radiology cases. Combined with a strong population health program, the UC Health team is making a real difference in their community."
"This accomplishment is due to our commitment to improved patient outcomes through the expanded use of information technology," said Jay Brown, UC Health's senior vice president and chief information officer, in a statement.
"As the region’s only academic health system, we are surrounded by innovators and visionary leaders who have recognized the importance of leveraging these tools," he added. "The HIMSS Analytics Stage 7 Award highlights our dedication to delivering the highest quality of care and enhancing the experience of our patients."
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