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    Most healthcare providers taking part in the federal EHR incentive programs give their patients access to their data – but fewer than 33 percent of patients actually take advantage of it, a recent report from the U.S. Government Accountability Office showed.

    Patients polled for the study said portals took too much time and effort it took to set up, complained about confusing interface design and said it was a challenge to juggle passwords for several different websites hosted by the places they get care.

    So what can the providers who deploy the portals and the vendors who make them do better? Lots, says Jan Oldenburg, founder of Participatory Health Consulting and editor of the recent HIMSS book, Participatory Healthcare: A Person-Centered Approach to Healthcare Transformation.

    [Also: GAO finds further proof patients are fed up with portals, EHRs]

    "We've known for an awful long time that patients are deeply frustrated with 'multi-portalitis,'" says Oldenburg. "If we were writing meaningful use regs today, we would pay much more attention to common data and helping people get access to a longitudinal record, rather than focusing on each provider doing an independent record of patient care."

    That's not just not good for patient access, of course, it's good for enabling better care coordination across provider settings.

    "Within communities, clearly physicians vendors, hospitals need to figure out how to join together their data, even if it means they have to give up a little bit of autonomy," said Oldenburg. "They have to figure out how to build common data sources so patients can go to whichever portal they're most comfortable with and see all their data."

    There are various ways of doing that, but better leveraging the myriad local, state and national health information exchanges could be a big one.

    "That means joining the HIEs, it means pulling HIE data into their EHRs so patients can see their data in one place and physicians can see all of the patient's record," she said. "It makes good sense. Most providers have some sort of HIE, or some type of access to community data. It's past time to figure out how to use that."

    The challenge, however, is that it's more or less up to the providers themselves, these days, to encourage each other to do that. The incentives of meaningful use have largely been exhausted, and the future direction of federal requirements isn't exactly crystal clear (evidenced, in part, by an president and a House of Representatives that would like to trim the budget for ONC by a drastic $22 million).

    So with the government's power to incentivize vastly reduced, and the onus for better data sharing left to the providers themselves, how confident is Oldenburg that it will happen?

    "Depressingly not so much," she said.

    "I have been out and about recently and have been having these depressing conversations with hospitals that say 'Oh, yeah, we contribute to the HIE but we don't pull their data in.' Or, 'We make it possible for our providers to see HIE, but it's a hassle and I don't think they do that very much.' Or, 'Our vendor provides for this common database, but I don't think anyone's providing data into it yet – we're sharing that, but we're not seeing much out of it.'"

    Still, all it takes is a few bold moves to bring some significant momentum, said Oldenburg.

    "It's like telephones or fax machines: There's this tipping point moment where value is created by critical mass, right? Where there's enough data in there that it's like, 'Eureka!' That, suddenly it's worth checking.

    "We're not there yet," she added. "I don't honestly know whether the model is going to be that everybody puts their data in HIEs, so the value come from checking the HIE. Or whether everybody starts pulling HIE data into their own repository and so you end up having community data available within your own system. But we're at the cusp of this tipping point, and you can start to imagine you might be almost there."

    To help us get there, it could move the needle in a not-insignificant way if patients continue to find their voice – making noise about getting easier and more intuitive access to their longitudinal health data.

    "We do know that it makes a difference when patients say to providers, 'This is matters to me, and I'm going to go find someone who's doing this if you're not going to,'" said Oldenburg. "But I worry about the rural and underserved areas where people are less savvy or perhaps don't know what to ask for, or what's possible. If those of us in more  connected areas are pushing for it, it's going to make it more of a habit and will start to push the envelope on it.

    Vendors also have work to do

    In the meantime, developers of patient portal technology have their work cut out for them as well, she said, starting with something that, in the age of ubiquitous and personalized consumer technology should be a given: simple, elegant, attractive and intuitive user experience.

    "If you look at the GAO report you will see that there is significant difference between the rates of adoption across differing vendors," said Oldenburg. "That seems to me to point to the fact that clearly some of the vendors are doing a much better job at UI than others.

    "That seems to me to say, 'Gee, guys, you can learn from one another,'" she added. "I don't know whether there is a way for vendors to get an unblinded version of their own information, but if you can it would be well worth looking at it – and figuring out what you're doing less well or more well, and doing more of what other people do well. Clearly, user interface does matter."

    Another area for substantial – perhaps fundamental – improvement is a rethinking about just what the existing generation of portals is offering to patients, said Oldenburg.

    "The other thing I saw in that GAO data, and I heard from patients as well, is that we've got to get a lot more creative about the features that we offer," she said. "You saw in that survey people saying 'I don't need to go to my portal. I only go around a visit. I go for the features that are useful, or to help me schedule appointments."

    In the 21st Century, digital tools are used in nearly every aspect of our lives. Portals could learn some valuable lessons from websites such as Amazon – to pick one example, based only on the fact that its founder this past week became, for a moment at least, the wealthiest man in the world.

    "Look at the ways people have gotten creative with online banking and shopping – anticipating the needs we might have, offering suggestions based on analytics about what we've done in the past and our patterns of behavior," said Oldenburg. "We could be doing that for health."

    Instead of just logging in once in a while to check lab results, schedule visits and get prescription refills, patient portals could "be much more effective in what we offer and how we offer it and how we make it convenient – going beyond that to anticipate the fact that we might be do for an appointment, or offering suggestions, or thinking about what behavior might be healthy and suggesting things, such as considering the way we walk, the route we take to work and offering suggestions for us," she said.

    "I think there are a lot of ways we could learn lessons from the creative digital approaches in other industries," said Oldenburg. "Both in the efficiencies that save money for the systems and time for us, but also nudge us into healthier behaviors."
     

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


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    Athenahealth revealed plans this week to change its executive organizational structure with a broad initiative to ratchet up profitability. Founder Jonathan Bush will continue as CEO but the company is looking to hire for his president and board chairman titles. 

    The strategic initiative is seen as a reaction to falling than rising stock prices, rumors that the cloud-based EHR vendor is ripe for a takeover, activist investor Paul Singer’s firm Elliott Associates acquiring nearly 10 percent of athena’s stock, and what Bush has publicly described as uncertainty around healthcare legislation that is bad for business. 

    [Also: Athenahealth swings to a profit on 15% revenue jump tied to population health, ambulatory and hospital services]

    “Athena is the rare, early stage growth company that has reached $1 billion in revenue. As Athena enters its next stage of growth, it needs a management team and operating plan that can successfully tackle the next stage of growth,” said T. Rowe Price New Horizons Fund portfolio manager Henry Ellenbogen. “This plan is a large step in the right direction. Athena can become a market leader and build a durable and sustainable company.” 

    In addition to bringing in a new president and chairman, the appraisal spans the company’s operational, financial and governance strategies, Bush said in a statement on Tuesday. The company also plans to roll out initiatives aimed at sharpening athenahealth’s focus by generating cost savings and reinvesting in its highest-value growth areas.

    [Also: Athenahealth CFO out as company looks for new leadership amid financial troubles]

    Investment firms UBS and Leerink posted positive feedback on athenahealth’s plan. UBS, for its part, said it expects that shifting to a more profit-focused model will help athenahealth reap new opportunities. 

    “We are encouraged by the move, the focus on operating margin expansion, and see the changes as largely beneficial for investors,” Leerink stated in its take on the initiative. “And we look forward to additional information and clarity surrounding the cost-cutting initiatives.”

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


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    Pew Charitable Trusts is calling on the U.S. Department of Veterans Affairs to prioritize patient matching, adopt better standards and improve interoperability as it transitions from VistA to a Cerner electronic health record.

    Outlined in a Tuesday letter to VA Secretary David Shulkin, MD, Pew’s chairmen highlight the need for seamless data exchange within the agency.

    “Information sharing  is essential to successfully implement your vision of seamless care, which is the ability for clinicians to have the data they need to coordinate how they treat veterans,” the group said.

    To accomplish this, Pew officials highlighted two major needs: patient matching and enhanced use of standards for clinical data elements.

    For patient matching, the VA’s IT system must accurately match records regardless of location. Pew is researching the best way to advance patient matching, through enhanced demographics, patient-led solutions and the like.

    The VA should study and prioritize patient matching enhancements as part of its health IT strategy and coordinate with the private sector. Shulkin has stated throughout his tenure that he values private-public partnerships, as he works to modernize the VA.

    Secondly, the VA should use enhanced standards of clinical data elements, like vital signs, medications and test results, which can also drive seamless care. These can allow providers to compare lab tests from different care settings and also supports interoperability.

    Specifically, the VA needs to work with the Department of Defense to align drug data updates. Currently, the agencies don’t follow the same schedule when updating medication information every month. As a result, providers often need to manually check the data for accuracy.

    “The VA system can reduce health IT-related medical errors by focusing on enhanced testing of EHRs and collaboration with the private sector,” Pew officials wrote. “To further safety, the VA can ensure the health IT implemented is tested for safety throughout its life cycle.”

    “By prioritizing ways to enhance patient matching, the standardization of data and EHR usability, veterans can have assurances they are receiving high quality, seamless and safe care,” they said. “The VA should make public how it address and incorporates these issues into its health IT strategy.”

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


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    EHR vendor drchrono has announced that its electronic health record, practice management and revenue cycle products now support the Fast Healthcare Interoperability Resources specification. 

    With FHIR, drchrono said it is enabling 10 million patients to access to their healthcare information via the FHIR API through the company’s inpatient health record.

    The new application programming interface is designed to support the Precision Medicine Sync for Science Initiative and fulfills one of the requirements of Meaningful Use Stage 3 to enable a patient health record API, the vendor said.

    Drchrono’s Patient API also gives users the ability to control their own data and share the data with others throughout the continuum of care. Any developer through the personal health record FHIR API can build applications on top of drchrono so researchers and other physicians with the patient’s approval can view that person’s data.

    Most developers know what APIs are, they know the modern technology stacks, but they do not necessarily know what HL7 or X12 are, the company said.

    FHIR, on the other hand, enables developers to move into healthcare and start building new apps as quickly as possible using concepts from other modern technology practices, he said.  

    The healthcare system increasingly requires a patient to play more of a part to ensure they are getting the right care in the right setting at the right time.

    “Increasingly, more of our healthcare system’s burden is on patients, when it comes to higher deductibles, the need for second opinions, the need to understand what preventive services are available to them,” said Aneesh Chopra, the former U.S. CTO and CEO of CareJourney. “That shift to more responsibility is concurrent with the need to have more information so you can get better at that step.” 

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    FHIR signals what may be the future of healthcare, and certainly what many wish that to be: An IT ecosystem where systems within an organization and between organizations can easily share data in a plug-and-play fashion.

    Healthcare as an industry is admittedly not there yet but thanks to the emerging Fast Healthcare Interoperability Resources standard, that picture is moving from an abstract vision to a more concrete reality.

    “Now we are entering an upgrade cycle where we no longer have to wait years and years for the next piece of health information to move,” said Aneesh Chopra, the former U.S. chief technology officer and current president of CareJourney. “We are now moving to a more modern technology stack that will dramatically increase cycle time to get information into the hands of people who can make the most sense of it.”

    [Also: HL7 publishes a new version of its FHIR specification]

    That’s important because data transfer in healthcare today is messy. Two different healthcare organizations trying to exchange information typically require a custom configured data transfer. So, for example, there has been nothing quite like HTTP with the Internet, where everyone knows that when you type a certain combination of letters, a specific action will happen.

    The FHIR specification is progressing. Vendors are supporting it. Developers can layer in the API to more easily transfer data. So what does the future hold?

    Democratized health data.

    [Also: FHIR holds big promise for interoperability, but will need to coexist with other standards for the foreseeable future]

    “FHIR is a common language to request medications, problem lists, a list of folks in the care team, that which the government has regulated, the common clinical data set,” Chopra said. “This democratizes access so even developers with very limited healthcare experience can more rapidly build what is in the best interest of patients. The FHIR API is really about democratizing access to healthcare – a common language and a universal plug.”

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


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    Cedar Valley Medical Specialists, based in Waterloo, Iowa, is eClinicalWorks' newest customer and will outfit more than 90 providers with the company's electronic health record and population health management software.

    The independent medical group will implement eCW's cloud-based 10e EHR and a suite of population health tools to help improve quality, drive patient engagement and enable better care coordination, officials said. CVMS will also deploy the company's healow patient portal.

    Despite the company's costly recent settlement with the U.S. Department of Justice, and recent reports showing that some clients plan to switch vendors because of it, eClinicalWorks continues to sign with new customers. In June, it was chosen by a federally qualified health center in New York to deliver EHR and pop health services.

    In an interview with Healthcare IT News this past week, CEO Girish Navani said the company has a "solid product line and success has been good for 17 years. … 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."

    "Our mission is to provide the highest-quality, most cost-efficient patient care in northeast Iowa, through a community of primary and specialty providers," said Gil Irey, CEO of Cedar Valley Medical Specialists, in a statement. "After transitioning to eClinicalWorks from Allscripts and GE, we now have more advanced tools to provide the enhanced patient care our practice areas offer."

    "By making the switch to eClinicalWorks, CVMS will now have the technology available to streamline and enhance the delivery of patient care," added Girish Navani, CEO and co-founder of eClinicalWorks. "We remain committed to enhancing the service to our customers and anticipate strong growth for the remainder of 2017."

    Twitter: @MikeMiliardHITN
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    In the wake of the eClinicalWorks False Claims settlement with the U.S. Department of Justice, the Office of the Inspector General sent an explicit message to all electronic health record vendors.

    “OIG will vigilantly, along with law enforcement partners, investigate any conduct that places patient safety at risk and that causes losses to the federal healthcare programs,” OIG senior counsel John O’Brien said. “We take the certification process for EHR software very seriously. There is no room for manipulating this process and making false statements during certification.”

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

    OIG’s message, which it posted as a YouTube video, comes as legal and industry experts are also expecting the DOJ to widen its probe into other EHR vendors certification status.

    “We’re entering an entirely new area of healthcare fraud,” O’Brien said. 

    O’Brien explained that eClincalWorks — which paid a hefty $155 million fine and agreed to a five-year Corporate Integrity Agreement another OIG official previously described as innovative — effectively caused hospitals using its software or cloud services to submit false claims because its software failed to meet the criteria required for certification.

    The Centers for Medicare and Medicaid Services has since said it will not punish hospitals that used eClinicalWorks in good faith to collect EHR incentive payments. 

    But OIG’s video confirms that it will pursue any electronic medical record vendors that may have made false claims or otherwise faked certification.

    “It’s very critical, just like in the written, the old medical records, that everything be accurate,” O’Brien said. “If there are any defects in EHR software program, then critical tests and medical prescriptions may not be accurately processed and that could have detrimental effects on patient care.” 

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


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    The Office of the National Coordinator for Health Information Technology revealed a new 5-year transition of its Health IT Certification Program’s existing testing portfolio to replace the current taxpayer-funded tools with as many industry-created options as possible.

    The Health IT Certification Program then can more efficiently focus its testing resources and better align with industry-developed testing tools, which potentially could help support the “real-world testing” envisioned by the 21st Century Cures Act, the ONC said.

    [Also: ONC looks to fill new Health Information Technology Advisory Committee]

    In June, the ONC approved the National Committee for Quality Assurance’s testing method for e-clinical quality measures as an alternative to the existing test method used in the ONC Health IT Certification Program.

    “This approval was a first step toward our five-year goal and is a clear signal that the program can and will approve industry-developed testing methods,” wrote Steven Posnack, director of the office of standards and technology at the ONC, in the Health IT Buzz blog. “Similarly, we are actively coordinating with standards development organizations, such as the National Council for Prescription Drug Programs for e-prescribing testing, and others that administer health IT interoperability testing tools.”

    [Also: House budget backs Trump's drastic cuts to ONC]

    These tools ultimately could serve as the sole testing method approved by ONC for use in the program, Posnack added.

    “Additionally, we envision a future where program participants, including the ONC-Authorized Testing Labs and Certification Bodies, individually, collectively or through partnerships with the private sector develop testing tools, similarly to what stakeholders do in other industry programs,” he wrote.

    ONC plotted out a 5-year transition noting that such changes will require time and potentially new cost structures depending on a variety of factors, including who develops the tools and the expenses that go into administering them.

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    When the U.S. Department of Veterans Affairs announced in early June that the agency would move its outdated EHR system to Cerner, Congress and President Donald Trump hailed the decision as the best route to data sharing between the VA and the Department of Defense.

    Many people in the government and healthcare sectors were surprised at how quickly the VA made its choice and the fact that it did so without the usual request for information and request for proposal procedures that are common in large-scale IT acquisitions. 

    [Also: Senate demands timeline on Cerner EHR project for VA, DoD]

    Now, a leaked audio obtained by Wired of a question and answer session with congressional interns led by presidential senior adviser and President Trump’s son-in-law Jared Kushner sheds some light on how the decision was made for the government to go with Cerner.

    “If you’re going to the VA, they basically have one source of customers, which is the Department of Defense. So what happened is, you leave the Department of Defense and it’ll take you about six months to get your medical records transferred over to the VA, which makes absolutely no sense why they’ve got two separate systems,” Kushner said.  “You should be, six months before you leave the Department of Defense, they should have the VA doctor start to check you, get your regimen, make sure your mental health is good, make sure you’re kind of adjusting back to civilian life the best way possible.”

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

    Kushner went on to discuss his meetings with VA Secretary David Shulkin, MD, and Defense Secretary James Mattis.

    “Dr. Shulkin and I talked about this issue, called Secretary Mattis, he sent over his top five people on the EMRs, and we got contract people from the VA on the EMRs, electronic medical records. We said, ‘Guys, we want a solution to some of the systems. It’s absolutely crazy.’ They came back in two weeks with something that made a lot of sense.”

    Kushner added that the VA has been holding hearings on what to do about its proprietary VistA EHR since 2000. 

    “So it’s been 16 years and nothing’s happened,” Kushner said. “We finally got everyone on the same page, and within two months started planning the migration of the whole system.” 

    The VA EHR is one piece of the government’ technological infrastructure that Kushner, who heads the American Office of Innovation, is looking to improve. 

    “We spend about $90 billion a year on IT and it’s really not very well run,” he said. “So we think there’s a way to save a lot of money, do it much better, and a much better technical infrastructure, for a lot of what really applies to the operations in government. That’s a big focus of ours.”

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    One sure way to reduce risky patient handoffs in a hospital, where the potential exists for miscommunication and medical errors, is to increase the length of shifts that physicians and nurses work. But a bleary-eyed doctor in the waning hours of a 30-hour shift presents its own patient safety challenges.

    "Why are we putting people at risk when really we just need to improve these handoffs?" said  William Floyd, president and CEO of the I-PASS Patient Safety Institute.

    It's been estimated that 80 percent of the most dangerous medical errors occur because of communication failures during handoffs, when docs and nurses change shifts, or patients are moved to new locations in the hospital.

    [Also: Patient safety jeopardized by EHR downtime, JAMIA says]

    Several years ago, a group of physicians and researchers devised a tool to bring some standardization to the hand-off process. I-PASS – Illness severity, Patient summary, Action list, Situation awareness and contingency plans and Synthesis by receiver – is meant to be a checklist that summarizes a patient's care plan and uses "closed loop communication" to ensure clinicians get the right information.

    The program was tested at nine pediatrics programs, and proved its mettle with some impressive safety gains. As noted in the New England Journal of Medicine, "medical errors decreased by 23 percent, preventable adverse events decreased by 30 percent, and critical information was included more frequently in written and verbal handoffs. And, importantly, handoffs weren't any more time-consuming than before." The program is now at use in about 50 hospitals nationwide.

    In 2016, the I-PASS Patient Safety Institute was launched as a company to help scale up those strategies, and bring the program's mentors, immersive online simulation training, benchmarking tools and EHR customizations to more locations.

    One of its newest clients is 496-bed Boston Medical Center, the biggest safety-net hospital in New England.

    "We needed to expand this to other hospitals because it's such a significant improvement to medical errors," said Floyd.

    Games, EHRs and the cloud

    At BMC, which has been using I-PASS processes since 2015, working with the Patient Safety Institute will help it better train incoming medical professionals, standardize hand-off processes more widely and initiate metrics and benchmarking, he said.

    "The training is an avatar-based gamification system," Floyd said. "It's immersive and drops you into an environment where you get rewards for achievement. It will allow a frontline provider to learn how to do an I-PASS handoff, and will then allow them to give an I-PASS handoff that then gets translated back to them, so they listen to their handoff. They do a scoring system and then that shows how well they've done compare with an exemplary handoff."

    There are many different handoff scenarios – nursing, pediatrics, surgery and more – with specific I-PASS techniques. The web-based training allows the ability to scale the approach across departments a fast and effective way.

    Electronic health record customizations are another important component, said Floyd.

    "Epic, Cerner, Allscripts all have the standardized I-PASS mnemonic in their system. And so what occurs is we help the hospitals customize that for each of the different care areas. We work with either the hospital's IT group, or we have third-party companies we work with who will then  make sure the I-PASS mnemonic is done (in the EHR) and is consistent with the standardized verbal hand-off."

    Cloud-based benchmarking software, available on smartphones, tablets and desktop offers a way to assess the success of how the program is being implemented.

    Hospital staff can simply tap on the elements of a particular handoff, "and it will then summarize how effectively it has been done and then do benchmarking across the hospital," said Floyd.

    "So, in the ICU it's being done at 70 percent, versus in surgery it's being done at 90 percent. You can benchmark across the hospital. And then you can also benchmark between hospitals: Mass General and Boston Medical Center can see how they are doing by comparison, and by care area."

    "The value of the I-PASS program is unquestionable in terms of improved patient care through reduction in medical errors," said James Moses MD, vice president of quality and safety and chief quality officer at Boston Medical Center, in a statement. "With the I-PASS Patient Safety Institute, we can continue to implement and sustain this important program in a fraction of the time we would spend doing it ourselves and with far fewer resources."

    "Effective and consistent training on an effective handoff process is a requirement by the Accreditation Council for Graduate Medical Education to prevent medical errors," added Jeff Schneider, MD, designated institutional official in graduate medical education at BMC. "We feel that the I-PASS Patient Safety Institute will provide the most efficient and effective way for Boston Medical Center to meet those requirements."
     
    As useful as the technology and tools are in helping train clinicians, there's no question that the I-PASS techniques require a substantial changes in process, workflow – even culture. And "that is by far the most difficult part of this," said Floyd.

    At a large institution such as Boston Medical Center, the company will deploy three to five certified mentors, who will develop a full program showing how to integrate it "into the departments, into the culture," he said.

    "These are very large, typically three-year programs," he said. "Because it is a cultural change, and that's exactly the most difficult part of this. Web-based measurement tools are important. But most important are our professional services, getting this detailed, what's the cadence of rollout, how do you customize this by different hospitals for their particular needs."

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


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    Allscripts announced on Thursday after stock markets closed that it is buying rival McKesson’s health IT unit.

    For $185 million in cash, Allscripts gains the product portfolio McKesson calls Enterprise Information Solutions consisting of the Paragon EHR, Star and HealthQuest revenue cycle technologies, OneContent content management tools as well as Lab Analytics and Blood Bank.

    Allscripts CEO Paul Black said that adding McKesson’s products will enable the company to increase its scale and drive innovation. “This transaction is expected to directly benefit existing clients and shareholders, as well as the Enterprise Information Solutions clients and team members we’ll welcome,” Black said in a statement.  

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

    To that extent, Allscripts sa will continue developing McKesson’s Paragon for small hospitals and target its own Sunrise EHR at larger systems and health networks.

    The combination of the two products, Allscripts said, will double its footprint among U.S. hospitals.

    Allscripts will invest in and continue to offer Paragon as the integrated EHR and revenue cycle management solution for the small hospital market segment, while Allscripts Sunrise™ will continue as the primary platform for larger institutions, typically with highly complex service line needs.

    After the proposed transaction closes, the combination of Paragon and Sunrise hospitals will double Allscripts current EHR hospital client count in the United States. 

    “The healthcare IT market remains highly fragmented,” Black said. “Today’s announcement is a strategic measure to maintain Allscripts leadership and position Allscripts for continued growth.” 

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    The Government Accountability Office on Thursday formally named 15 health technology professionals to the new Health Information Technology Advisory Committee. 

    “It is extremely valuable to have a range of perspectives and expertise in helping the government address challenges related to health information technology,” said Gene Dodaro, Comptroller General of the United States and head of the GAO. 

    The advisory committee will provide recommendations to the National Coordinator for Health Information Technology on policies, standards, implementation specifications, and certification criteria relating to the implementation of a health information technology infrastructure that advances the electronic access, exchange, and use of health information.

    The committee provides recommendations to the National Coordinator for Health Information Technology on policies, standards, implementation specifications, and certification criteria for EHRs. 

    Newly appointed members will serve for one-, two-, or three-year terms. All members may be reappointed for subsequent three-year terms.

    Members appointed for one-year terms:

    • Michael Adcock, executive director of the Center for Telehealth at the University of Mississippi Medical Center
    • Terrence O’Malley, a geriatrician at Massachusetts General Hospital and Spaulding Nursing and Therapy Center North End
    • Carolyn Petersen, Senior Editor for Mayo Clinic’s health information website.
    • Sasha TerMaat, a director at Epic Sytems, where she oversees regulatory and quality reporting activities.
    • Andrew Truscott, a managing director for Health and Public Service at Accenture

    Members named for two-year terms:

    • John Kansky, President and CEO of the Indiana Health Information Exchange
    • Denni McColm, CIO at Citizens Memorial Healthcare in Bolivar, Mo.
    • Brett Oliver, CMIO for Baptist Health in in Louisville, Ky.
    • Raj Ratwani, Acting Center Director and Scientific Director of the National Center for Human Factors in Healthcare within MedStar Health
    • Denise Webb, CIO of Marshfield Clinic Health System and CEO of Marshfield Clinic Information Services.

    Members selected for three-years:

    • Christina Caraballo, Director of Healthcare Transformation at Get Real Health, a health information technology development company in Rockville, Maryland,
    Tina Esposito, Vice President of Information and Technology Innovation at Advocate Health Care, a hospital network in Illinois
    • Brad Gescheider, Senior Director of Provider and Payer Solutions at PatientsLikeMe
    • Kensaku Kawamoto, Associate Chief Medical Information Officer, University of Utah Health, and Assistant Professor, University of Utah Department of Biomedical Informatics.
    • Sheryl Turney, Senior Director of All-Payer Claims Database Analytics and Data Policy and Administration at Anthem Blue Cross Blue Shield
     

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


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    EHR vendor Epic Systems came under the gun again this week over data sharing and access. 

    Generally, the criticism is that Epic claims its electronic health record system is interoperable while most of the health data exchange takes place among other hospitals also using Epic, rather than rival EHRs. 

    But now it’s about patients’ right to access their entire medical record. Politico reported on Wednesday that “Epic CEO Judy Faulkner asked Biden during an (until now) private meeting between EHR executives and administration officials, 'Why do you want your medical records? They’re a thousand pages of which you understand 10.’ Biden responded, ‘None of your business. If I need to, I’ll find someone to explain them to me and, by the way, I will understand a lot more than you think I do.' ” 

    In a response seeking comment, an Epic spokesperson said: “Epic supports patients’ rights to access their entire record, something they have been able to do for decades. Vice President Joe Biden was consistently polite and positive to every person, including every vendor, in the meeting.” 

    The Epic spokesperson added that in the January meeting Faulkner raised an issue regarding the 21st Century Cures Act that would potentially require a patient’s EHR information be transmitted in a way that was easy to understand.

    Faulkner said that a requirement to translate EHR medical terminology into patient-friendly language could be a barrier to getting the medical record out to patients.

    “That’s actionable,” Biden agreed, and requested that one of his staff get the requirement fixed, the Epic spokesperson said. 

    The report, not surprisingly, sparked debate on the internet about patients rights to access their own health data versus the reality that many health records contain language that most patients would find difficult to understand. 

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    Linguamatics, whose AI and machine learning algorithms fuel natural language processing technology for text mining, is joining forces with RealHealthData, which works with medical transcription companies to populate its database of narrative medical records.

    Cambridge, UK-based Linguamatics' I2E technology is able to pore through a variety of text resources, such as EHR data and clinical trials information. Santa Cruz, California-based RealHealthData maintains a detailed database of provider notes. Together they'll use NLP to better understand an array of clinical data.

    [Also: EHR natural language processing isn't perfect, but it's really useful]

    One aim is to give pharmaceutical and biotech companies better insight into the real-world impact of patient therapies, rather than having to rely clinical trial data, according to the companies.

    "We believe this partnership will enhance the value we can provide our life science customers for health economics and outcomes research, epidemiology, and medical affairs,” said Jane Reed, head of life science strategy at Linguamatics.

    Medical records offer a key trove of such data, which could can inform drug development and beyond, but it's often unstructured. Linguamatics I2E can extract key facts from the narratives in RealHealthData's database, which covers every medical specialty, by using specific ontologies and queries for better decision making.

    Unstructured EHR text offers a level of detail that's not available in the structured fields that life science companies are used to. RealHealthData's trove of patient records include narrative information such as patient social status and clinical notes such as comorbidities, complications, co-medications, lab values, adherence or switching issues.

    Manuel Prado, CEO of RealHealthData, said customers of the companies "can now access the unique and valuable insights in the database using a first-in-class, healthcare-specific natural language processing platform."

    I2E technology can mine large amounts of unstructured data – incorporating machine learning to directly specific patients, such as diabetics who smoke and are overweight, said David Milward, chief technology of Linguamatics, using longitudinal data to look at outcomes or behavior over time.

    Twitter: @MikeMiliardHITN
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    Speculation about Amazon and Apple positioning themselves to enter the EHR market has been based on acquisitions of companies and talent recently.

    With an EHR market that is ripe for disruption, will the tech giants take the leap? Neither Apple nor Amazon has formally revealed any intentions to build an EHR, but they’ve made some moves since January offering plenty of speculation. 

    Click to the next slide to learn more

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    July 31, 2017

    Any play for a significant piece of the healthcare sector by Apple or Amazon – such as building a new EHR – would likely prove dubious and be “an uphill battle to compete in the larger segments of the market.” 

    Here are the reasons why

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    July 27, 2017

    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. 

    Learn more

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    June 27, 2017

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

    Learn more

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    June 15, 2017

    The effort to make all personal health information available via its devices would be a first for Apple, which until now has focused its healthcare work on fitness and wellness with its Apple HealthKit. Apple has been typically mum on the developments and CNBC, which first reported Apple’s latest intentions for healthcare, said the works have thus far been “secretive.”

    Learn more

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    June 23, 2017

    Timeline: From the launch of its HealthKit API in September 2014 to revelations this month of EHR-like work with a tiny startup, it’s clear that healthcare is in Apple’s eye.

    Learn more

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    June 14, 2017

    Boston Children’s collaborated with Duke Health System to develop the new Caremap app using Apple CareKit. The first version enables family members and caregivers to track and store medical information and health metrics and then share that data with doctors and clinicians to inform pediatric patient care.

    Learn more

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    June 2, 2017

    Apple's ResearchKit: Ready for healthcare or far from useful? ResearchKit launched two years ago and uses iPhones to gather health data, enabling researchers to conduct studies using that information.

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    June 13, 2017

    Apple has hired Sumbul Desai, MD, clinical associate professor of medicine at Stanford. Desai is also vice chair of the Department of Medicine and chief digital officer at Stanford Center for Digital Health. Desai will serve in a senior role at Apple in what appears to be a growing healthcare team, CNBC reported on June 8, adding she would continue to see patients at Stanford.

    Learn more

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    March 8, 2017

    WebMD has tapped Amazon Alexa to enable users to launch the WebMD skill on any Alexa device. With Amazon’s Echo, Echo Dot and Amazon Fire TV, users can ask questions about a range of health-related topics including conditions, medication, tests and treatments. Alexa will respond with WebMD-sourced answers in easy-to-understand language. 

    Learn more

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    Feb. 23, 2017

    Praxify, a healthcare information technology company to ease physicians’ lives, unveiled MIRA, a mobile app designed to improve EHR usability and performance, and SIYA, a care management workflow system for payers, providers and patients.

    Learn more

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    Speculation about Amazon and Apple positioning themselves to enter the EHR market has been based on acquisitions of companies and talent recently. With an EHR market that is ripe for disruption, will the tech giants take the leap? Neither Apple nor Amazon has formally revealed any intentions to build an EHR, but they’ve made some moves since January offering plenty of speculation. 

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    When a receptionist hands out a form to fill out at a doctor’s office, the questions are usually about medical issues: What’s the visit for? Are you allergic to anything? Up to date on vaccines?

    But some health organizations are now asking much more general questions: Do you have trouble paying your bills? Do you feel safe at home? Do you have enough to eat? Research shows these factors can be as important to health as exercise habits or whether you get enough sleep.

    Research has begun to show that a person’s ZIP code can be as important to her health as her genetic code.

    That’s why Shannon McGrath was asked to fill in a “life situation form” this spring when she turned up for her first obstetrics appointment at Kaiser Permanente in Portland, Ore. She was 36 weeks pregnant. (Kaiser Health News is not affiliated with Kaiser Permanente.)

    “When I got pregnant I was homeless,” she said. “I didn’t have a lot of structure. And so it was hard to make an appointment. I had struggles with child care for my other kids; transportation; financial struggles.”

    The form asked about her rent, her debts, her child care situation and other social factors. Based on her answers, Kaiser Permanente assigned her a “patient navigator.”

    “She automatically set up my next few appointments and then set up the rides for them, because that was my No. 1 struggle,” McGrath said. “She assured me that child care wouldn’t be an issue and that it would be OK if they came. So I brought the kids and everything was easy, just like she said it would be.”

    Her navigator helped McGrath get in touch with local nonprofits who helped her with rent, a phone and essentials for the baby — such as diapers and bottles — all in the hope that making her life easier might keep her healthier and, in turn, keep KP’s medical costs lower.

    McGrath said her patient navigator, Angelette Hamilton, was a bureaucratic ninja, removing paperwork obstacles that kept her from taking care of herself and her family.

    Patient navigators have been around for a while. What’s new is the form McGrath filled out and how hospitals are using the socioeconomic data the forms glean to serve patients. The details now go into a patient’s file, which means providers such as Dr. Sarah Lambert have more information at a glance.

    “I find it incredibly helpful because it can be very hard to find out,” said Lambert, who is McGrath’s OB-GYN and works at Kaiser Permanente Northwest. “Having it coded right there — we have this problem list that jumps up — really can give you a much better understanding as to what the patient’s going through.”

    Federal officials introduced new medical codes for the social determinants of health a few years ago, said Cara James, director of the Office of Minority Health at the Centers for Medicare & Medicaid Services.

    “More providers are beginning to recognize the impact that the social determinants have on their patients,” she said.

    Nicole Friedman, a regional manager at Kaiser Permanente Northwest, agreed. But she goes one step further.

    She hopes giving doctors more information about the home life of each patient will push health care in a new direction — away from more high-priced treatments and toward providing the basics that protect a person’s health.

    “My personal belief is that putting more money into health care is a moral sin,” she said. “We need to take money out of health care and put it into other social inputs, like housing and food and transportation.”

    Linking health organizations like KP with nonprofit social services such as the Oregon Food Bank will help governments and medical providers see where their money can make the biggest difference, Friedman said.

    For example, spending more on affordable housing for homeless people can also have health benefits — in turn, saving the government money down the line.

    Friedman said that when KP started addressing people’s social needs, one study found a 40 percent reduction in emergency room utilization.

    McGrath was initially skeptical when doctors offered to help her with things like rent and transportation.

    “I didn’t want someone to see my situation and have it raise alarms,” she said.

    But ultimately she was glad to have shared that information.

    “I’m able to look at life and not feel overwhelmed or burdened,” she said, “or like I’ve got the whole world on my shoulders.”

    This story is part of a partnership that includes Oregon Public Broadcasting, NPR and Kaiser Health News.

    Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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    University of California San Diego Health on Monday announced that it is putting its Epic electronic health record in the cloud.

    The transition from managing its own on-premise Epic EHR to a cloud-based service has already involved moving some 10,000 workstations and integrating more than 100 third-party apps with Epic’s cloud, UC San Diego Health said.

    [Also: Hospital datacenters: Extinct in 5 years?]

    While hospitals and health systems have historically been somewhat tentative about mass migrations to the cloud, industry luminaries such as Beth Israel Deaconess Medical Center John Halamka, MD, have been making bold predictions of late about datacenters vanishing as hospitals go the cloud for analytics, EHRs and clinical decision support. Halamka, for one, backed that claim up by placing 7 petabytes of BIDMC data on Amazon’s cloud.

    UC San Diego Health, for its part, said the move is an early milestone in its three-year plan to migrate all of its data storage needs to the cloud -- not just Epic’s hosting environment, of course, though they have yet to divulge other clouds.

    UC San Diego Health Associate Chief Information Officer Mark Amey said shifting to Epic’s cloud enables the hospital system and its clinics to be more agile and responsive while maintaining disaster recovery capabilities.

    “By creating greater operational efficiencies,” Amey said, “we can invest more time and resources in patient care.”

    UC San Diego also said that in November it will start sharing the new EHR with UC Irvine Health.

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    Remember this catchphrase: healthcare is local.

    Allscripts revealed late last week that it is purchasing McKesson’s health IT business and, for $185 million in cash, it obtained approximately 500 hospital customers comprising 5 percent more of the EHR market than it had before the deal.

    That means Allscripts market share for hospitals in the U.S. and Canada more than doubled to 10 percent, according to HIMSS Analytics.

    Matt Schuchardt, HIMSS Analytics director of business development and innovation, pulled some data from HIMSS Analytics’ LOGIC health IT market intelligence platform to create these two maps.

    You can see how Allscripts customers were geographically distributed prior to the deal. Compare the maps by moving the white bar, on right of screen, to the left.

    Now, Allscripts is headquartered in Chicago and the lion’s share of its customers previously resided east of the Mississippi — save for that pocket in and around Saskatoon in Saskatchewan, Canada.

    But in the second map you can see McKesson’s presence west of the Mississippi River, including mid-western states such as Iowa and Arkansas as well its strong stamp on the West Coast near its San Francisco, California headquarters.

    “This pushes Allscripts across the country more than it was before,” Schuchardt said. “This makes them a national competitor, a player in every state.”

    Whereas it’s tempting to think that EHR vendors are already competing across the country, the above maps, when taken together, show that Allscripts was more prominent east of the Mississippi.

    Which brings us back to that opening slogan. Just like care delivery is local, there are significant advantages for EHR vendors to have a footprint in specific regions.

    “EHR vendors struggle to sell to physician practices or regional health centers if there are no other customers around that they can connect to,” Schuchardt said. “So the question is: Will Allscripts hold McKesson’s market share or does the acquisition help them grow the combined market share?”

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


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    The embattled electronic health records and health IT vendor eClinicalWorks has exchanged in 12 months more than two million documents via the eClinicalWorks EHR through the Carequality Interoperability Framework. The real-time data transfer between disparate systems facilitates coordination of care between providers in various care settings and helps ensure they have more complete and accurate patient information at the point of care.

    Carequality is a national, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks.

    This latest news gives some momentum to other data-sharing efforts by eClinicalWorks. The vendor’s client Eagle Physicians & Associates exchanged health data with hospitals running rival Epic’s EHR also through the Carequality Interoperability Framework in June.

    [Also: eClinicalWorks adds telehealth feature to mobile app]

    All of this news comes after a $155 million settlement in which the U.S. Department of Justice charged eClinicalWorks with fraudulently obtaining certification under the meaningful use EHR program that enables customers to attest to certain criteria and, in turn, collect reimbursement incentives from the federal government. According to the settlement, eClinicalWorks must either upgrade existing customers for free or transfer their data to rival EHRs.

    The bad news for eClinicalWorks hasn’t stopped the EHR vendor from winning new customers, though. For example, in early June, federally qualified health center Ezras Choilim signed on for the vendor’s EHR and population health cloud services.

    [Also: eClinicalWorks to pay $155 million to settle suit alleging it faked meaningful use certification]

    And in July, Central Florida ACO, NEXT ACO of Nature Coast and Space Coast ACO contracted for the vendor’s Population Health Management technology for their combined 90 providers and more than 17,000 beneficiaries.

    In June, on another front, eClinicalWorks added telemedicine functionality to its mobile app. The company’s device-agnostic platform offers practice management and patient engagement tools. The addition of the TeleVisits feature appears to be designed to nudge eClinicalWorks into the one-stop-shop domain.

    Back in the realm of Carequality Interoperability Framework data sharing, some eClinicalWorks clients are quite happy with the vendor’s achievement of exchanging more than two million documents in 12 months.

    “At Coastal Medical, we are dedicated to providing our patients with the highest quality care possible,” said Mice Chen, CIO of Coastal Medical. “That requires sharing important health data between our providers at other hospitals and facilities in the state.”

    With the adoption of the Carequality Interoperability Framework, through the organization’s eClinicalWorks EHR, the organization can retrieve critical patient health data from Lifespan hospitals that use Epic and make the organization’s patients’ data available to them, Chen added.

    “This seamless information sharing, from within the EHR, helps bridge gaps that existed in the past and helps us in the systematic coordination of patient care by being able to potentially prevent duplication of services and costly hospitalizations and ER visits,” Chen said.

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


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    The veteran executive proposes a multi-pronged approach to ending the tyranny of wasted time and effort created by today’s technologies.

    The HITECH Act resulted in near universal adoption of electronic health records (96 percent in hospitals and nine out of ten physician offices, according to the latest ONC tally) and having all that clinical information in electronic form is a remarkable advance. 

    It enables a wide range of possibilities for improving care, assessing its value, and managing populations in ways that might actually improve our collective health and reduce the overall healthcare bill. On the most basic level, caregivers should have an easier time getting up to speed on each patient's history and current condition than in the old days where they had to thumb through a paper chart trying to decipher other physicians' handwriting. Moreover, this advance means that patients can become more active and equal participants in their care; they can use their phones to discuss healthcare issues with their care team and see when they last had a tetanus shot.

    But this significant progress in adoption also gave rise to concerns about the usability of EHRs.  

    Physicians are spending twice as much time with their EHRs as they do with patients, according to a time and motion study published last fall by the AMA. In the most recent Medscape Lifestyle Report, a survey of 14,000 physicians, EHRs were the fourth most common cause of burnout EHR complaints beat out insurance issues, threat of malpractice suits, concerns about salary, and patient volume.

    EHR-induced patient safety problems related to usability are becoming a concern. A 2015 study published in the Journal of Patient Safety described almost 250 cases where EHR glitches or poor human factors were alleged to have caused patient incidents led.

    Why have usability issues come to dominate so many discussions about EHRs?

    First, change is hard, and EHRs are a big change, especially for clinicians who spent decades perfecting their use of paper charts. Any time you introduce new technology and new processes deep into the fabric of someone’s work routine, there will be significant struggles and bumpy transitions that might last years.

    Second, if you're used to whipping off a prescription in five seconds, spending thirty seconds to enter the same information into the computer must seem like an absurd imposition, even if it does make the information exquisitely readable and simultaneously accessible to all authorized users. The same is true of many formerly paper-based tasks that now require clinicians to enter structured terms into fields. Those extra few seconds per task, multiplied by dozens of tasks, can add hours to the workday.

    Third, the user interface design of EHRs can be sub-par. Compared with the smartphone tech we carry in our pockets, many EHR user interfaces feel like a throwback to the 1990s, and too many clinicians have tales of needing a dozen clicks to order a single drug, or being harassed by alerts to the point where they just ignore them all.

    In fairness to EHR developers, automating healthcare tasks presents an exceptionally difficult design challenge. Medicine is based on a very complex body of knowledge, encompasses dozens of specialties, and tackles thousands of different diseases. Ideally it requires an application that can aggregate patient histories, lab values, medical images, monitor tracings, vital signs, progress notes, and miscellaneous other pieces of information, process them, analyze them, and send them back to the clinician with notes on best practices and relevant recent research. Compare that task to designing an application that supports the six transactions we might want to make at an ATM.

    Fourth, in our collective efforts to improve care we have moved more and more work onto the shoulders of the clinician. Asking patients about the safety of their homes, engaging them in discussions about smoking cessation, counseling them about the importance of taking their medications, and documenting interactions using structured vocabularies ­– all of these actions could benefit patients. But their cumulative impact on a clinician can be overwhelming.

    In some ways, beating up EHR vendors on usability is a form of shooting the messenger. Clearly the vendors have work to do, but others created the tyranny of large numbers of good ideas of work for the clinician.

    What’s more, physicians often don't directly benefit from investing all this extra time.  It's legitimate for them to ask, "What's in it for me and my patients?"

    The benefits of EHRs seem to accrue to the healthcare system as a whole, or to payers--not to physicians, unless their compensation is adjusted.

    Eventually, a value-based reimbursement model should reward their effort, but that prospect probably seems very far away to most.

    So, what can we do to significantly improve the usability of electronic health records? There is no single strategy or tactic that will address all these factors. 

    We can make significant strides with a multi-faceted approach:

    Policy: We must continue our efforts to move to value-based reimbursement. Not only is this model good for patients, it will help us focus on what information we really need out of our EHRs in order to assess value and identify ways to increase it.

    We can give clinicians appropriate incentives by basing their compensation on outcomes so that they see a clear reward from using the EHR to ensure that their care follows the evidence.

    We must continue to work with CMS, state Medicaid programs and private sector health plans and purchasers to focus on changing reimbursement, so that those who are doing quality work see a reward for their efforts.

    We should strive to rationalize and coordinate the demands for quality measures and documentation so that our clinicians don't have to jump through multiple hoops with data entry in order to report essentially the same piece of information to multiple places.

    We must also push for national usability standards and industry-wide efforts to improve our knowledge of best usability practices.  The 14 basic principles laid out by the American Medical Informatics Association in 2013 were a great start. Keep your eye on this initiative out of the National Institute for Standards and Technology, and the usability framework being developed by the American Medical Association and MedStar Health’s National Center for Human Factors in Healthcare. 

    We should support EHR safety improvement efforts such as those being advanced by the National Patient Safety Foundation and the ECRI Institute.

    Products: Providers must keep the pressure on their vendors to explore ways to smooth the collection of information and review of results. Context-aware software can whittle down choices to a manageable number so that users don't have to scroll through dozens of options every time they need to enter an order. Advanced data visualization can help users focus on the most important information and correctly interpret that information.

    Natural language processing is already making amazing progress at interpreting free text and pulling out individual data elements. It can potentially liberate clinicians from clicks and pull-down menus entirely.  Combined with advanced voice recognition, it could even save them from typing. 

    Beyond these innovative technologies, providers should also insist that their EHR vendors take advantage of the wealth of knowledge about best user-centered design practices. EHR vendors can learn from other industries and from consumer-oriented technologies.

    Process: While we are busy working to improve policy and products, we can also make usability gains by improving our clinical and operational processes.

    Consider technologies that allow you to compare how your clinicians use your EHR. You may find that one physician is taking five clicks and eight seconds to complete a task, while another is talking seventeen clicks and thirty seconds. Understanding why these differences exist can point to supplementary training needs and additional changes in workflow.

    Look for ways to distribute the EHR-related workload. Some tasks can probably be taken off the physician’s shoulders and given to other members of the care team, or even to the patient.  Some organizations have approached this distribution using scribes, who follow physicians around and enter the data for them. The American College of Medical Scribe Specialists projects that there will be 100,000 active scribes by 2020, roughly a five-fold increase over current levels. That's about one for every nine doctors. 

    Finally, healthcare executives and clinicians need to keep educating themselves.  Every widely used EHR has some customers that show high adoption and satisfied clinicians. They will be popular speakers at industry and user group meetings. Find out their secrets and steal them. Organizations can also learn from themselves. It's crucial to have an open, candid, and ongoing internal dialogue about what's working and what isn't.

    Our national efforts to improve health and healthcare will rely on a solid base of electronic health records that are used well and materially assist the efforts and knowledge of caregivers and the patients. Advancing EHR usability is not impossible, or even particularly mysterious. But it is complex and it won't happen by itself.  We must keep the pressure on our policymakers, our vendors, and ourselves.

    John Glaser, Ph.D., is Senior Vice President, Population Health, of Cerner Corporation. Prior to this position he served as the Chief Executive Officer of the Health Systems Business Unit at Siemens. He is the author of several books including “Glaser on Health Care IT” published by HIMSS Books. 

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    Cerner's John Glaser: How to finally fix the EHR usability problem

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