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    Azalea Health, a web-based healthcare systems and services vendor, is merging with Prognosis Innovation Healthcare, a vendor of an electronic health records system targeting rural and community hospitals.

    Azalea’s expertise is in the cloud-based IT, billing and reporting space for rural health clinics and hospitals. Leveraging the integration of the Prognosis inpatient EHR system will enable Azalea to expand its presence into the 50 or fewer bed hospital space to deliver a complete continuum of care platform to an expanded rural market segment, Azalea said.

    [Also: EHR vendor drchrono says task management app will improve workflows]

    “Hospitals and medical practices in rural settings are struggling mightily to answer an incredibly unique set of challenges when it comes to access, cost control, technology and more,” said Baha Zeidan, founder and CEO of Azalea Health. “Innovation is critical to their ability to navigate the shift to value-based care and to deliver services in rural markets, a market that has 1,300 critical access hospitals.”

    Bringing Azalea and Prognosis together, the two companies now can help these provider organizations more effectively create a single medical record that follows patients throughout their healthcare experience, Zeidan added.

    [Also: OurHealth taps athenahealth to integrate Salesforce, portal, other apps]

    Rural hospitals, clinics and ambulatory practices now will be able to create clinical, financial and quality-driven outcomes with a single platform that lets services be pushed to the lowest cost provider in that continuum, he said.

    Azalea Health now services thousands of ambulatory and hospital-based healthcare providers nationwide, across more than 30 medical specialties, and manages billions of dollars a year in healthcare charges processed through its platform, the company said. With the merger, Azalea will maintain its headquarters in Atlanta and maintain satellite offices in Macon and Valdosta, Georgia, and Houston, Texas, with nearly 150 employees across the country.

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

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    KLAS partnered recently with the College of Healthcare Information Management Executives to ask more than 100 healthcare organizations about their plans for telehealth deployments.

    Despite ongoing questions about reimbursement and regulation, virtual care platforms are finding favor for scheduled and patient-focused visits, on-demand and consumer-focused meetings and telespecialty consults, the groups found.

    [Also: CIO shares keys to a successful telehealth program]

    The benefits to patients have been worth the efforts to expand their reach, KLAS and CHIME said, even given the continuing uncertainty and financial challenges.

    Cost, reimbursement levels, issues with the technology itself and its impact on the patient experience were among the concerns voiced by those providers surveyed. Nonetheless, most said they planned to either expand their telehealth programs to improve patients' access to care.

    The report sees telehealth being used for three main purposes: patient-focused visits, enabling patients to schedule clinical meetings virtually; on-demand or consumer-focused purposes, to decrease the costs for patients and providers by dealing remotely with urgent or non-emergency care, and telespecialty consultations, connecting patient with specialists by video.

    Patient convenience was one of the top drivers for telehealth, according to KLAS and CHIME –  who noted that the success of the medium depends on patients having a high opinion of its value.

    "Telehealth offers a great opportunity to enhance the lives of patients by making healthcare accessible to them wherever they may be," said Russell P. Branzell, CEO and president of CHIME. "Our members are advocates for improving patients' lives through innovations like telehealth. But it needs to be carefully implemented to meet its potential and we still face headwinds with reimbursement and integration issues."

    Indeed, about half of those interviewed for the study said reimbursement was a challenge, with payers – whether private insurers, Medicare or Medicaid – often slow to reimburse virtual visits at rates comparable to face-to-face care. That often makes it hard for hospitals to make a compelling business case for telehealth, even if it's valuable for patients.

    "Billing and reimbursement are factors that limit our ability to expand our telehealth program," said one director interviewed for the report. "There are things that we would like to expand to, but we just can’t get paid for them yet, so that is the major hurdle for us at the moment. In our state, we get reimbursed for the vast majority of telemedicine. We are getting reimbursed for about 90 percent of our telehealth visits. But there are some things that we would like to do that we can’t get the health plans to pay for and that the state doesn’t reimburse us for."

    "The funding for telehealth, in general, is not where it needs to be," said another VP. "There is an out-of-pocket component, but if our most vulnerable populations who need telehealth don’t have the financial resources to pay for that care, they go without it. So telehealth services should be available for everyone. That is where the reimbursements need to come in."

    Technology integration challenges were another big concern. Many respondents reported that integration between their electronic medical record and virtual care platform was "nonexistent or unidirectional," according to KLAS and CHIME.

    "Telehealth holds enormous promise," said Adam Gale, president of KLAS. "However, the underlying technology needs to evolve faster. In particular, integration of telehealth with provider EMR's is still at a primitive level. Vendors need to step up in terms of technology and improved support."

    Those challenges aside, telehealth's forward momentum seems to be continuing as more and more providers see the value it creates for their patients and for their own population health management strategies.

    "We are going to provide a level of convenience for our patients that they want," said one healthcare executive. "Providing an opportunity for patients to receive care is what patients are going to appreciate. Another benefit is the care outcome for patients. Telehealth helps increase compliance rates for patients who are discharged and need follow-up appointments."

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

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

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

    Updated Oct. 12, 2017

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    Slideshow Title: 
    Arkansas Oral Facial Surgery Center
    Slideshow Description: 

    Arkansas Oral Facial Surgery Center was hit by a cyberattack that shut the organization out of files, medical images and details of patient visits. An investigation found the cyberattack occurred between July 25 and 26, and while quickly detected, the virus encrypted x-ray images, files and documents of patients who visited the provider within three weeks prior to the incident.

    Read the full article

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    Augusta University Medical Center
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    While officials say less than 1 percent of patients were impacted by the breach, this is the second time the organization has been hit with a successful phishing attack within the last year.

    Read the full article.

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    MongoDB databases
    Slideshow Description: 

    Three hacking groups are once again targeting MongoDB databases, hijacking 26,000 open servers and asking for a ransom to release the data, according to security researcher Victor Gevers, chairman of the GDI Foundation.

    Read the full article.

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    Medical Oncology Hematology Consultants
    Slideshow Description: 

    The cyberattack was discovered on July 7, but the attack began nearly a month earlier on June 17. Officials said the hackers targeted certain electronic files on the provider’s server and workstation

    Read the full article.

     

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    Kaleida Health
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    While only 744 patients were included in this month’s breach, Kaleida Health already notified 2,800 of its patients in July of a separate phishing incident.

    Read the full article.

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    Mid-Michigan Physicians Imaging Center
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    Just over 106,000 patients of are being notified by Mid-Michigan Physicians Imaging Center of a potential data breach of their personal health information. The records of both past and current patients may have been accessed after the McLaren Medical Group – which manages Mid-Michigan – discovered a breach of its Radiology Center computer system in March.

    Read the full article.

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    St. Mark’s Surgery Center
    Slideshow Description: 

    St. Mark’s Surgery Center discovered a ransomware attack on May 8, although the attack occurred from April 13 until April 17. The installed virus prevented patient data from being accessed during that time. The impacted servers contained patient names, dates of birth, Social Security numbers and medical information of this Florida provider.

    Read the full article.

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    Pacific Alliance Medical Center
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    Los Angeles-based Pacific Alliance Medical Center disclosed that it was hit by a ransomware attack in June. In August they determined that the breach involves the health information of 266,123 patients.

    Read the full article

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    Plastic Surgery Associates of South Dakota
    Slideshow Description: 

    The cyberattack was first discovered in February, but crucial evidence was lost during the investigation on April that rendered it impossible for officials to rule out a breach.

    Read the full article

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    Anthem BlueCross BlueShield
    Slideshow Description: 

    Anthem BlueCross BlueShield began notifying customers last week of a breach affecting about 18,000 Medicare members. The breach stemmed from Anthem’s Medicare insurance coordination services vendor LaunchPoint Ventures, based in Indiana.

    Read the full article

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    Women’s Health Care Group of Pennsylvania
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    The breach on Women’s Health Care Group of Pennsylvania was discovered in May, but hackers had unauthorized access to the system as early as January.

    Read the full article.

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    Peachtree Neurological Clinic
    Slideshow Description: 

    While Peachtree Neurological Clinic avoided paying ransom after a recent cyberattack, the investigation that followed revealed a hacker had access to its system starting in February 2016.

    Read the full article

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    UC Davis Health
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    An employee of UC Davis Health responded to a phishing email with login credentials, which officials said the hacker used to view patient data and send emails to other staff requesting large sums of money.

    Read the full article.

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    Verizon's data breach
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    As many as 14 million U.S. customers of the telecommunications company were exposed after a user mistake caused a database to go public online.

    Read the full article.

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    Bupa global health insurance
    Slideshow Description: 

    A Bupa employee -- who has since been fired -- copied private information from global health insurance policies, which cover those who frequently travel or work overseas.

    Read the full article.

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    Indiana Medicaid
    Slideshow Description: 

    Indiana’s Health Coverage Program said that patient data was left open via a live hyperlink to an IHCP report until DXC Technology, which offers IT services to Indiana Medicaid, found the link on May 10. That report, DXC said, contained patient data including name, Medicaid ID number, name and address of doctors treating patients, patient number, procedure codes, dates of services and the amount Medicaid paid doctors or providers.

    There were 1.1 million enrolled in Indiana's Medicaid & CHIP program in April 2017 according to KFF.org.

    Read the full article

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    Cleveland Medical Associates
    Slideshow Description: 

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

    Read the full article

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    Airway Oxygen
    Slideshow Description: 

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

    Read the full article

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    Feinstein & Roe MDs; La Quinta Center for Cosmetic Dentistry
    Slideshow Description: 

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

    Read the full article

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

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

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITNDataBreach-undisclosed.png
    Slideshow Title: 
    Torrance Memorial Medical Center
    Slideshow Description: 

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

    Read the full article

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

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

    Read the full article.

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/breaches-150-countries.png
    Slideshow Title: 
    National Health Service in England and Scotland
    Slideshow Description: 

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

    Read the full article

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

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

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

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2093k.png
    Slideshow Title: 
    Harrisburg Gastroenterology
    Slideshow Description: 

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

    Read the full article

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    Slideshow Title: 
    Bronx-Lebanon Hospital Center
    Slideshow Description: 

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

    Read the full article

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

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

    Read the full article

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

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

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2020k.png
    Slideshow Title: 
    Lifespan
    Slideshow Description: 

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

    Read the full article

    Slideshow Image: 
    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%20918k.png
    Slideshow Title: 
    HealthNow Networks
    Slideshow Description: 

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

    Read the full article

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

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

    Read the full article

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2080k.png
    Slideshow Title: 
    Washington University School of Medicine
    Slideshow Description: 

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

    Read the full article.

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2017k.png
    Slideshow Title: 
    Metropolitan Urology Group
    Slideshow Description: 

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

    Read the full article.

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    Slideshow Title: 
    Denton Heart Group
    Slideshow Description: 

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

    Read the full article.

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2014k.png
    Slideshow Title: 
    Brand New Day
    Slideshow Description: 

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

    Read the full article.

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    Singh and Arora Oncology Hematology
    Slideshow Description: 

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

    Read the full article.

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    http://www.healthcareitnews.com/sites/default/files/HITN%20Data%20Breach%2010k.png
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    Verity Medical Foundation-San Jose Medical Group
    Slideshow Description: 

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

    Read the full article.

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    Slideshow Title: 
    CoPilot Provider Support Services
    Slideshow Description: 

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

    Read the full article.

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    Indiana-based Cancer Services
    Slideshow Description: 

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

    Read the full article.

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

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

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    At the end of the day Wednesday, Tate Gilchrist was surprised he had not lost his voice, given all the questions he had fielded at the Cerner Annual Conference 2017 that ends Thursday in Kansas City.

    Gilchrist is a senior business developer for open platform services at Cerner.

    His work entails a lot of talk about third-party apps – and it seems like every conference attendee wanted to know more.

    “For the first time ever, we’re able to, at scale, demonstrate how Cerner is working with third parties to take their technology and put it inside our EMR workflows so our providers can have choices and be able to use the applications that they choose to use,” Gilchrist told Healthcare IT News.

    The technology that makes it possible is “SMART on FHIR.”

    “SMART on FHIR” is very much a buzzword in the industry right now,” Gilchrist said. “It’s an open standard. It’s also very disruptive and innovative. It’s something everyone wants to talk about. We’ve had demos, we’ve had presentations, we’ve had interactions adhoc with more clients than I can count,” he said. “We’ve had conversations with other Cerner employees to show them what is possible so they can get back to their Cerner client and say you know there are some things that are possible, you know, we should check them out.”

    Across the country, there are more than 13,000 users of third-party applications.

    The No. 1 application is one developed by First Data Bank called “Meducation.”

    “It’s in production at several of our sites now,” Gilchrist said.

    The app makes it possible for providers to look at a foreign application as it sits almost natively inside of the Cerner EMR and to determine what the patient’s medication list is and then print off patient education about that medication – in different languages and fonts.

    While Cerner has not developed any of these applications, it has developed the underlying technology that supports and facilitates third-party companies to build applications, Gilchrist said. “When they build the application, we use the technology – it’s technology that is freely open and available to the entire client base.”

    At the end of the day, Gilchrist said he and his team were happy to share what “we’re doing in our little business unit.”

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

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    At the 2017 Cerner Health Conference this week, attended by more than 16,000 customers from around the world, the company put interoperability and patient access front and center.

    First, Cerner announced a new consumer-directed patient record, "at our cost," said Cerner President Zane Burke.

    That means, he explained, that Cerner "will work in concert" with a given provider's patient portal so every patient "has the ability to take our information and create our own experience."

    [Also: Cerner's third-party apps draw crowds at annual conference]

    The tool would enable health records to be shared together in one place, rather than separate providers running on separate systems.

    He added that "it's time for the patient to be part of the care team, and it's time for us to embrace that."

    Burke also announced an extension of free CommonWell services to Cerner customers, for three more years through 2020.

    Cerner, of course, was one of the founding members of the CommonWell Health Alliance, alongside competitor EHR vendors such as Allscripts, athenahealth and Greenway.

    Since its launch in 2013 – and since Cerner first offered free access to the service at the Cerner Health Conference the following year – the initiative has grown significantly, with more than five dozen companies enabling easier data sharing across 60 million patient records.

    "It shouldn't matter if it's Cerner's EHR or someone else's EHR," said Burke. "We need data from multiple places, and we need that data to flow freely."

    Just how to define interoperability has often been a point of contention in the healthcare industry, but for Cerner the definition is simple, he said: It's "Can I have my patient record?" 

    That patient-focused approach to data exchange is especially poignant at this user conference, the first since the passing of Cerner founder and CEO Neal Patterson this past summer, followed shortly afterward by Patterson's wife, Jean Lillig Patterson, who had spent years fighting breast cancer while transporting her own medical charts from doctor to doctor.

    Before he died, Patterson implored his company to "fix Jeanne’s health record," according to the Kansas City Business Journal.

    That's part of the impetus behind the re-upped commitment to CommonWell and the consumer patient record, Burke told the KCBJ.

    "If you want your health record, you should be able to have it, much like a bank account and an ATM," he said. "You have to think about that consumer-directed patient health record in the same way."

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    Email the writer: mike.miliard@himssmedia.com

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    Epic Systems CEO Judy Faulkner drove a stake into the ground when she said the company is transforming today’s EHR into a Comprehensive Health Record, a.k.a CHR.

    But health and IT executives should take note: The new moniker does not mean that Epic has intrepidly moved into undiscovered country. Instead, rival EHR makers are already taking a similar tack. It’s just that no one has publicly attempted such a bold rebranding of the category.

    “We’ve been discussing longitudinal health records that include social determinants and other relevant data for at least two years now, and there are more than 100 clients today using Cerner’s population health management platform (including many Epic EHR clients),” Cerner President Zane Burke said. “We’ve worked with these clients to develop solutions like HealtheIntent that are EHR-agnostic and aggregate data from multiple, disparate sources outside the four walls of the hospital or clinic.”

    [EHR satisfaction survey 2017: After years of frustrations, user wish-list turns positive]

    Cerner is by no means alone in saying it is already working toward a more comprehensive health record. Executives from eClinicalWorks and athenahealth also noted they are broadening the types of information included in the electronic health record — though each is doing so in slightly different ways.

    What is a CHR, exactly?

    Faulkner said Epic is thinking about how to approach a CHR in three ways. First, the system will include information not in EHRs today; that’s where social determinants come in. Second, the CHR should include data about care delivered outside the hospital. Third, CHRs will incorporate information about care that was traditionally managed inside the hospital but has since or will in the future move outside a provider’s walls, whether via telehealth apps or otherwise.

    That’s what Epic means. Here’s what Cerner, eClinicalWorks and athenahealth have in mind.

    Cerner’s Burke said the company has worked with its clients to build products – HealtheIntent is one – capable of pulling in data from otherwise disparate sources outside the four walls of the hospital or clinic and are EHR-agnostic.

    Burke this week at Cerner’s user group unveiled a free consumer health record for patients that, not altogether unlike the Share Everywhere interoperability tool Epic introduced at its own user group last month, works with a portal to enable patients to access their own information. He also said Cerner would continue to offer interoperability services under the CommonWell Health Alliance free to existing customers until 2020.

    And looking ahead Burke promised the vendor would equip next-generation interoperability with the ability for “data to flow freely,” between its own Millennium EHR and other vendors’ software.

    eClinicalWorks CEO Girish Navani said his company also envisions the need for a broader platform in the digital healthcare system.

    “The EHR is an ever-evolving technology and incorporating further advancements will make enormous impacts in healthcare,” Navani said.  

    [Also: Epic CEO Judy Faulkner is standing behind switch from EHRs to 'CHRs']

    Navani added that eClinicalWorks’ new EHR, version 11, which was released late last week, consists of cloud-based connectivity, interoperability, intelligence with genetic screening for precision medicine, predictive risk models for population health, and patient engagement features including telehealth services.

    When asked about making its cloud-based EHR services more comprehensive in the vein of Judy Faulkner’s plans, athenahealth Chief Product Officer Kyle Armbrester answered that it’s a good step in the right direction.

    “What we need more than anything is a platform that’s actually able to work atop all of that information. Just having it sitting there isn’t actually going to solve healthcare problems,” Armbrester said. “We have some of that, where providers capture things, for example, there might be a spouse abuse issue, we capture that.”

    That said, there are of course hurdles to creating such a Comprehensive Health Record, according to Blain Newton, Executive Vice President of HIMSS Analytics.  


    Read more Innovation Pulse colums from Healthcare IT News.


    “There is absolutely a need to ensure that a patient’s electronic health record is comprehensive,” Newton said. “The challenge has been, and will continue to be, the integration of data not only from within the various EHRs, but the disparate sources that are coming on-line that contain different types of PHI.”

    A comprehensive health record also has to keep pace with expanding volumes of data, Newton added, and that requires analytics capabilities running on top of integrated, structured data to distill the right information for providers.

    While no vendor has formally rechristened the EHR as a CHR — and that may or may not ever actually come about — hospitals should anticipate their vendors will begin moving in that direction. Just don’t expect it to happen overnight.

    “It’s where healthcare must go,” Cerner’s Burke said. “It’s interesting others are just now getting attention for that thought, but it’s certainly going to take more than changing the name.”

    Healthcare IT News Editor-at-Large Bernie Monegain contributed to this report. 

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

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    In a firm, bulleted-list, notable author and physician-scientist Eric Topol, MD, sparked a Twitter debate on his insights about the barriers to giving patients their medical record -- and why the shift needs to happen.

    “Hospitals won’t or can’t share your data… Your doctor (more than 65 percent) won’t give you a copy of your office notes,” Topol tweeted. “Access or ‘control’ of your data is not enough.”

     

     

    The tweet has been shared about 775 times and liked by more than 1,200 users.

    It also sparked further conversations that expanded on patient rights to own their medical data, which included moving beyond a patient-centered record.

    “Hence, [it’s] important not to lose out and just be patient-centered,” tweeted Amir Hannan, MD, chair of Association of Greater Manchester Local Medical Committees. “[It] needs to be jointly managed and supported with coaching too.”

    The debate of data ownership has been a hot-button topic for years. Topol, along with Katherine A. Mikk and Harry A. Sleeper of Mitre's Open Health Services, discussed how to shift medical data ownership to the patient in a Sept. 25 JAMA article.

    To accomplish the shift, the authors laid out three essential steps: establish common data elements, provide patients with a ‘data receipt’ and manage ownership through data use agreement contracts.

    In Aug., Epic Systems CEO Judy Faulkner asserted that the EHR giant fully supports patient access to their entire record -- something the company has supported for the last 10 years. But the barrier is with translating EHR medical terms into patient-friendly language.

    As part of the 21st Century Cures Act, the language may require a patient’s EHR data to be transmitted in a way that would be easy to understand.

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    While much of the population health management work hospitals are undertaking today relies on EHRs, new research from KLAS uncovered a crop of technology companies gaining purchase in the realm: IBM Watson Health, Philips Wellcentive and HealthEC. 

    EHR vendors athenahealth, Cerner and Epic are still seeing stronger deployment of their pop health tools than these third-party vendors, KLAS noted. 

    Research firm BlackBook said over the summer that Epic, Cerner and Allscripts are poised to dominate the population health market as a wave of mergers, acquisitions and consolidation is coming. 

    [Also: Population health is in a major state of change]

    Here’s the rub: “No one tool is yet used for all basic functionalities,” KLAS found.  

    KLAS, in fact, identified six verticals of IT functionality required for PHM: data aggregation, data analysis, care management, administrative and financial reporting, patient engagement and clinical engagement.

    “Since many organizations are trying to get as close as they can to a one-stop shop, EMR vendors see strong cross-vertical deployment,” the report said. And that’s where the plot twists a bit. “New vendors have emerged, resulting in a diverse array of technologies that may address one or all of the different PHM verticals.”

    To that end, KLAS cited IBM’s string of acquisitions including Phytel and Explorys building out Watson’s strengths, Philips Wellcentive broadening in those vertical capabilities and HealthEC’s nimble development as making them pop health management options for hospitals looking outside their EHR vendor’s existing product portfolio. 

    Exactly who will win out in the long-run, however, remains to be seen and even though KLAS called out the aforementioned vendors specifically as leaders it included a total of 23 companies in its broader population health lineup. 

    It’s also worth noting that pop health is a broad and continually advancing trend -- meaning that hospital technology needs, too, will change moving forward. 

    HIMSS Analytics, in fact, said in mid-September population health today is primarily a manual process but the firm expects that to change as the technologies mature. 

    “As provider organizations enter into more risk-based agreements, what they need and expect from PHM solutions evolves,” according to the report. 

    Twitter: @Bernie_HITN
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    Any health system trying to tackle population health management in any meaningful way has to grapple with the challenge of patients who don't adhere to their care plans – especially those who, for whatever reason, don't take their medicines in the way they were prescribed.

    "Medication nonadherence is a massive public health problem," said Niteesh K. Choudhry, MD, executive director of the Center for Healthcare Delivery Sciences at Boston's Brigham and Women's Hospital.

    "We estimate that almost $300 billion a year is spent in caring for health conditions that are attributable to nonadherence – that amount of money could be saved if patients were fully adherent to their medications," said Choudhry, who will keynote the second day of the HIMSS Big Data and Healthcare Analytics Forum in Boston on Oct. 24.

    [Register Now: Upcoming HIMSS Big Data & Health Analytics Forum]

    Worse, from a quality and safety perspective, all sorts of things – "11 percent of all hospitalizations and other staggeringly high numbers" – can be directly attributed to patients failing to take their meds on time, in the right dosage or at all.

    "Nonadherence is a really common and prevalent and costly issue," said Choudhry. "And it threatens a lot of the investments we've made in developing new therapies, and testing and rigorously proving their value and then disseminated to practitioners and patients that they're available."

    While the U.S. spends billions of dollars developing new therapeutics, those investments won't do much good if the drugs aren't taken as physicians say they should be.

    [Also: Social determinants of health and the $1.7 trillion opportunity to slash spending]

    So what's the answer to better health? Innovating on more and more medicines, or getting better at ensure they're put to work on the people who need them most?

    "There's a tremendous efficiency loss in the money we're already spending," said Choudhry. "And so if you had to spend another dollar, the next marginal dollar, on how to improve healthcare quality, getting people to do what we already know how to do, or what we've already proven works, is almost certainly a more efficient strategy."

    Population-level studies have shown that medication adherence is only about 50 to 60 percent. Some patient populations are higher-risk and some are lower, but that's about the average.

    [Also: MGMA: Predictive analytics is now a business necessity for healthcare]

    "The question becomes, if we know this – for example, if we take one condition such as heart disease, which is what a lot of my work is about, and we know that this is a super common condition and that a million people per year still have a heart attack, despite our availability of very evidence-based therapies – the question becomes how can we prevent those health events from happening?" said Choudhry.

    There are two options, he said: "Either we can develop new therapies to reduce the risk of heart disease even further, or let's get people to use the therapies we already have but they aren't using."

    Sounds simple enough, right? Not quite.

    "The reason why patients don't adhere to their medication are complex," said Choudhry. "Most people have more than one reason to be nonadherent and one person's reasons may be profoundly different than another person's reasons."

    That said, "from a pure efficiency perspective, getting people to adhere to their medications, while extremely difficult to do, is almost certainly more efficient than developing new therapeutics which people won't take."

    Too often, said Choudhry, "when we think about interventions, what we've done in general is a one-size-fits-all approach: We'll say, 'We know that cost is a barrier to adherence and so let's eliminate cost for all patients with a given condition. We'll just make medications free and see what happens.'"

    On one hand, that may seem like an effective strategy. After all, it's easy to do and there isn't any targeting necessary of specific patient populations. But it's not as effective as it might be.

    "There are many patients for whom cost is not the barrier, so there is a misapplication of what we're doing and what they really need," he said.

    If we know each nonadherent patient had a different reason for that – maybe it's cost, or maybe it's competing priorities, or confusion and uncertainty, or fear of potential side effects – the question becomes: how to ascertain that?

    "That's where predictive analytics is really coming into play," said Choudhry.

    First, analytics can help health systems figure out who does and doesn't need an intervention. ("Half of people do adhere to their medications, and so it doesn't make a ton of sense to intervene with people who don't need help.")

    Second, it can help us predict who is and who isn't adherent now, and who will and will not be adherent in the future – as well as when patients will become non-adherent," he said. "We've made good headway on that problem, predicting who to target."

    Predictive strategies can also "help identify who's most likely to benefit from certain types of intervention – that's really where the future of predictive analytics lies," he said. "We can identify timing. And we might be able to begin to identify barriers people have and what might be reasons they're not adherent using big data.

    "But the Holy Grail of health behavior change in general, and certainly when it comes to nonadherence, is to be able to use data to figure out responsiveness," said Choudhry – how well a given patient will respond to a given type of clinical outreach.

    "The future is in figuring out what patients' true barriers are, and then figuring out whether or not they'll respond to a specific intervention or not," he said.

    Tips for other hospitals and health systems looking to embrace these techniques?

    "Don't fall into a one-size-fits-all approach," said Choudhry. "We now have decades of research of saying, 'Here's a simple intervention, let's apply it to everybody,' and often finding that the interventions don't work as a whole.

    "The idea of personalizing interventions – just as we believe in personalized medicine and cancer therapeutics – this is the same idea, but just on the other end of the translational research spectrum," he added. "Improving healthcare quality and getting people to engage with healthcare really will require a large degree of personalization."

    Another piece of advice is to use "existing and available techniques from big data – methods to predict who will be nonadherent in the future – which you can readily get from insurer claims data by applying published approaches," he said. "That's the second stage and it's already something people can begin to do and large health insurance companies are doing this every single day. They're certainly approachable."

    Finally, it's key to keep an eye on the future, said Choudhry.

    "Even though the technology to ultimately apply these techniques is still being developed, it's not that far off," he said. "We've come a long way in the past five or seven years in this space, and I expect five years from now will be quite distinct. People should stay tuned."

    Twitter: @MikeMiliardHITN
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    When it comes to doctor burnout, technology is both the problem and a potential solution.

    “Let’s not dance around it – we all know how much the electronic health record has contributed to the physician burnout epidemic,” said Bridget Duffy, MD, chief medical officer at Vocera, co-founder of the Experience Innovation Network and former chief experience officer at the Cleveland Clinic.

    “Physicians who once were absorbed in speaking with and examining their patients found themselves spending more time clicking through screens and pecking away at a keyboard.”

    [Also: Epic's rival EHR vendors say they too are making the 'CHR' switch]

    The widespread frustration felt by doctors wrangling with kludgy interfaces, interminable sign-ins and so many clicks is well-trodden at this point. Perhaps less understood, however, is how technologies including EHRs can be tuned to make physicians more efficient — and more happy.

    Your IT: It just has to work

    Making sure that the tools IT provides to doctors and, in some cases, mandates they use, actually work as it’s supposed to sounds basic but we all know that doesn’t exactly happen every time. 

    Eliminating EHR downtime and service interruptions is one way to make life easier for all medical practitioners that engage the technology on a regular basis, said Scott Alldridge, CEO of the IT Process Institute.

    [Also: EHR satisfaction survey 2017: After years of frustrations, user wish-list turns positive]

    “Having systems not working properly, broken or simply not available is problematic, and downtime is much more frequent statistically than most users and organizations realize,” Alldridge said. “This is costly and can cause much user frustration and stress.”

    Further, healthcare organizations should ensure an EHR is well integrated with all critical systems and data, making it much easier for practitioners to get to the information needed quickly – and hopefully with ease, for example, using things like single-sign-on technologies, he said.

    Easing the doctor’s overwhelming paper problem with better document management and data abstraction can help ease the stresses that lead to physician burnout, said Par Bolina, MD, chief innovation officer at health IT consulting firm IKS Health.

    “Even in the digital age of EHRs, one of the greatest challenges physicians face today is appropriately collecting, filing and capturing clinical data from the mountains of paperwork that their offices still receive,” Bolina said. “Important test results are sometimes lost amidst the large amount of paperwork still being sent from outside specialists and diagnostic centers.”

    And in the exam room, while trying to see their patients, precious time can be lost while doctors search for scanned reports in EHRs. Clinically relevant information must be identified and filed in the appropriate discrete data fields of an EHR.

    “This means that the information is quickly searchable and readily available during a visit,” Bolina said. “It also means that the information is reportable and contributes to the critical clinical quality reporting that organizations require in a world of value-based care.”

    Communication is critical

    Hospitals and tech vendors alike must identify and understand the inherent trauma that antiquated systems, technologies and complex processes have imposed on clinicians.

    Duffy cited three tactics that can make a difference today in facilitating a better human-to-human connection between clinicians and patients.

    First, healthcare organizations need to use technology that streamlines communication inside and outside the four walls of the hospital.

    “Physicians and nurses are constantly leaving messages for each other, as it’s rare to connect on the first attempt,” Duffy said. “Imagine the stress it causes to be in such frequent wait-mode, especially if you need to speak to someone about urgent health matters. By mapping the gaps in communication processes between physicians, nurses and other care team members, hands-free communication devices and secure smartphone apps can reduce a 30-minute wait to a near instant transaction.”

    Second, hospitals and clinics should seek technology solutions that reduce the burden of repetitive data input that now takes place and enable seamless ways for clinicians to talk to each other, Duffy advised.

    And third, hospitals need metrics to assess whether a technology actually eases the burden of being a doctor or a nurse, Duffy said. Healthcare organizations need to measure things like staff well-being or burnout and clinician resilience before and after a new technology or process improvement initiative is deployed.

    “The right technology can, to a surprising degree, help ease burnout among clinicians by simplifying processes and removing hassles,” Duffy said. “Reconnecting people back to purpose and utilizing technologies that enable a healing interaction will allow clinicians to have joy back in the practice of medicine.”

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

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    Pine Rest Christian Mental Health Services, which includes a psychiatric hospital and a variety of mental health services, is preparing for an Epic Systems electronic health record rollout.

    Pine Rest’s board of directors has approved the multi-million-dollar capital investment, which was announced on Oct. 3.

    Regarding the cost, Pine Rest executives call it a “significant investment.”  Financing will be a blend of longer-term debt, board designated funds as well as capital improvement dollars.

    The go-live date is too early to tell, but executives are shooting for June 2018.

    Headquartered in Grand Rapids, Michigan, Pine Rest provides services at clinics across Michigan and also in Central Iowa.

    Epic EHRs are already used by some of Pine Rest’s partner hospitals, such as Metro Health – University of Michigan Health, Spectrum Health, Sparrow Health and Lakeland Health.

    The goal is for Pine Rest patients to have their behavioral healthcare integrated with their physical care and to provide patients with access to both through MyChart, Epic’s patient portal.

    “The head and the body belong together,” Epic founder and CEO Judy Faulkner, said in a statement. “This collaboration will help Pine Rest take care of the whole patient through both an integrated record and the improved interoperability they will gain with Care Everywhere.”

    Pine Rest plans to connect with other hospitals, such as Mercy Health Saint Mary’s, through Great Lakes Health Connect. Epic’s interoperability platform, Care Everywhere, exchanges 2 million records per day with both Epic and non-Epic systems, according to Epic executives.

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    The American Medical Association has launched the Integrated Health Model Initiative, a platform it says will help move the healthcare industry toward a common data model and pioneer a shared framework for organizing health information.

    Early participants in the project include American Medical Informatics Association, Cerner, IBM, Intermountain Healthcare, SNOMED International and others. Any healthcare stakeholder is invited to join.

    "We spend more than $3 trillion a year on healthcare in America and generate more health data than ever before," said AMA CEO James L. Madara, MD, in a statement announcing the initiative. "Yet some of the most meaningful data – data to unlock potential improvements in patient outcomes – is fragmented, inaccessible or incomplete."

    [Also: EHRs are holding troves of genomic data, too bad it's not always easily usable]

    IHMI aims to help technology vendors and healthcare providers "better learn how to collect, organize, and exchange patient-centered data in a common structure that captures what is most important for improving care and long-term wellness, and transform the data into a rich stream of accessible and actionable information," said Madara.

    The IHMI comprises three main strategies. First, it seeks to convene clinical and issue-based communities focused on specific problematic areas such as hypertension management and diabetes prevention, aiming to develop data best practices for patient-centric care.

    Second, there's the development of a clinical validation process, where participants will offer online feedback to help specify data elements and relationships that will then be validated for clinical applicability, according to AMA

    Third, participants will help create a strategy to encode information in the IHMI data model, with reference value sets that can be shared and distributed.

    "I am excited about IHMI because it builds on the foundation of interoperability standards that are being created by HL7, LOINC, and SNOMED International," said Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, in a statement. "If we persist, that approach will lead to the ability to exchange medical knowledge as executable software rather than as journal articles. If we can do it, it will be a historic evolutionary step for medicine."



    By embracing such a model, with common and clinically-validated data elements, healthcare organizations can improve their information management, analytics and decision support, according to AMA, and pave the way toward better interoperability, more efficient data structuring, improved workflow – and, ultimately, care models that lead to better patient outcomes.

    "Ensuring the accuracy and completeness of the information used to manage a person's care is a priority for Cerner, so we are happy to support this AMA initiative to improve the semantics of clinical data models," said David McCallie, MD, senior vice president for medical informatics at Cerner. "This represents a bold attempt to advance an important aspect of interoperability."

    Twitter: @MikeMiliardHITN
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    The $2.7 trillion that America spends on healthcare every year is overshadowing doctors’ ability to provide quality care to patients — but that dark cloud also shines a light on the opportunity, and the need, to better control spending.  

    “Cost is the number 1 threat to quality in the United States,” said Peggy O’Kane, founder and President of the National Committee for Quality Assurance. “It hurts the ability of doctors to do a good job. We have a lot of high deductibles that stand in the way of getting the kind of primary care and chronic disease management care that people need.”

    [Also: Patient experience: Where does it actually begin?]

    Joining O’Kane at the NCQA Quality Talks event on Monday in Washington, DC, Maria Gomez, CEO and Founder of Mary’s Center, said that medical care contributes to 10 percent of patients’ overall health, genetics are at 30 percent, social and environmental determinants are 20 percent and some 40 percent depends on individuals’ behavior.

    “We know this but we do exactly the inverse,” Gomez said. “We spend 70 percent on the medical piece and maybe 30 percent on creating safe neighborhoods, affordable housing, great schools for everyone, not just specific zip codes.”

    Martin Makary, MD, a professor of surgery at Johns Hopkins University School of Medicine, said the appropriateness of care is driving the cost crisis and he cited a national survey that found medical professionals estimated that 21 percent of care is unnecessary.

    “That’s the opportunity to fix our broken healthcare system,” Makary said. “We need to find a way to measure it and we need to address it.”

    O’Kane said that the healthcare industry needs to embrace continuous quality improvement.  

    “Three things we have to work on: quality of healthcare, customer service, and the most important and compelling right is now cost,” O’Kane said.

    To that end, O’Kane explained that quality is about more than numbers and algorithms and, instead, involves both saving lives and improving quality-of-life for patients.

    The customer service piece, otherwise known as patient experience, is no longer a nice-to-have, and O’Kane said that plenty of research and literature exist to show that patients are more receptive and compliant when they feel like they are important in the healthcare system.

    And then there’s the massive issue of healthcare costs.

    “One way to cut costs is to skinny up the benefits with high deductibles and co-insurance, the other way feels even more draconian and that it is to take coverage away,” O’Kane said. “I personally believe every American should have health insurance. The hard road is cutting costs without compromising quality.”

    That will require both technology and kindness, said Lynn Banaszak, the founding executive director of the Disruptive Health Technology Institute.

    “We need to keep innovating but we also need to readjust our perspective about being bigger, faster and stronger by adding kindness into the mix,” Banaszak added.

    Banaszak cited research that found 75 percent of study participants answered that they would pay more for kinder care and 88 percent are willing to travel farther to receive it.

    “Let’s be bigger than an acrimonious healthcare debate that no longer focuses on what matters most: how our healthcare system is treating people every day,” Banaszak said. “Technology and kindness.”

    On the technology front, O’Kane added that both EHRs and quality reporting have made life miserable for doctors and we cannot have burned out physicians on the front lines while trying to control costs and improve care quality.  

    “We all have a noble mission here. We have a lot of work to do to have quality not hated by practitioners,” O’Kane said. “We have to make quality reporting supportive to practitioners, not a burden. We need to persist in this mission of driving continuous quality improvement.”

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    But experts at Monday’s National Committee for Quality Assurance event say cutting costs without compromising quality is the hardest part.

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    The Allscripts EHR now can link with healthcare information and appointment booking app Zocdoc through Zocdoc’s participation as an integrator in the Allscripts Developer Program. This will enable a connection by API between Zocdoc’s online scheduling platform and Allscripts’ clinical scheduling software.

    The integration will improve real-time booking for patients through Zocdoc and will enable physician offices to have synced schedules and appointment information, the companies said. The integration is available for new and existing practices using both Zocdoc and Allscripts.

    [Also: Allscripts picks Vidyo to add telehealth features to patient portal]

    “At Zocdoc, we believe in creating open, interoperable technology that provides value for patients, providers and the greater healthcare industry,” said Joaquin Gamboa, chief legal officer and head of new business and government affairs at Zocdoc. “We’re proud to work with Allscripts to help physicians maximize their time, create efficiencies for office staff, improve access, and deliver the simple, connected experience patients expect.”

    Zocdoc’s digital marketplace surfaces unused appointment inventory in real time, improving patients’ access to care, the company explained. According to a recent Merritt Hawkins study, the average wait to see a new primary care physician is 24.1 days. The typical Zocdoc appointment takes place in under 24 hours, the company said.

    [Also: Fighting physician burnout: How tech can undo the damage done by EHRs]

    “From independent physicians to large health systems, all providers need EHRs that are complete, connected, and tailored to their needs,” said Allscripts general manager, open business unit, Tina Joros. “We’re pleased to work with Zocdoc to help streamline booking for innovative practices across the US.”

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    Genomic sequencing has come a long way in a short time, and its potential to drive even faster innovations in precision medicine is enormous.

    To capitalize on that opportunity, however, health systems need data – lots of it, from all sorts of people. Kaiser Permanente has been building a biobank with genomic data and other health information from hundreds of thousands of patients from across its eight regions, and Nazneen Aziz, says it's already helping clinicians unlock insights into complex genetic challenges.

    Aziz, executive director of Kaiser Permanente Research Bank, spoke during a HIMSS Learning Center webinar this past week, explaining the ways biobanks, with their data linked to electronic health record systems, are helping drive research discoveries at Kaiser and providing an opportunity for other health systems to collaborate.

    A key catalyst for this innovation, of course, is the arrival of next-generation sequencing, which Aziz calls "the enabler of genomic medicine as it is today."

    The Human Genome Project paved the way, and it seems hard to imagine a time, 13 years ago, when it cost $3 billion "just to get one human genome fully sequenced," she said. "Now, with next-generation sequencing, we're able to sequence individual genomes for under $1,000, and it's now come into the clinical realm."

    Next-gen sequencing is "enabling large-scale scale sequencing very rapidly," said Aziz. And even in a U.S. healthcare system notoriously slow to adapt to change, it's being adopted fairly quickly, generating large volumes of increasingly complexity, from gene panels to whole exomes to whole genomes.

    A challenge, however, is that "there is a big knowledge gap in clinical genomics," she said. "We know there are about 20,000 protein coding genes, and for about 5,000 of these genes we know their function – but we don't know the function of another 15,000 or so."

    That, said Aziz, is "where population biobanks are critical."


    Learn more: How Genomic Data Banks Are Enabling Progress in Precision Medicine


    More data from more people with more genomic profiles is essential if clinical researchers are going to be able to solve the mysteries – of which there are still many – of how genetics contribute to disease.

    For instance, "we know that there are only about 667 validated drug targets," said Aziz. "And we know there are about 4,000 monogenic diseases, caused by mutation in a single gene."

    But "while interpretation of protein-coding parts of the genome is somewhat mature, we still don't know how to interpret the parts that are in-between genes," she said. "Interpreting other parts of the genome is still in its infancy."

    And recent years, for example, have revealed the importance of the intergenic region, DNA sequences between genes, which had previously been discounted or overlooked.

    Indeed, the workings of monogenic diseases, caused by modifications in a single gene, such as sickle cell anemia or cystic fibrosis, versus complex or multi-genetic diseases (diabetes, obesity), which often develop in tandem with environmental or lifestyle factors, can be "hard for even physicians to understand sometimes," she said.

    But the bigger and more diverse the data trove researchers can work with, the easier it is for them to arrive at genomic insights and develop new treatment strategies.

    There are many biobanks around, the world, from the VA's Million Veteran Program, currently the largest in the world, to other large troves in the UK, China, Taiwan and Japan. But many biobanks are located at hospitals and health systems – not just at Kaiser Permanente, but Mayo Clinic, Geisinger Health System and more.

    "Many hospitals are starting to do their own collection," said Aziz. "Now that the technology to sequence large numbers of patients has become so affordable and high-throughput, you are now able to connect the genomic sequence to the electronic health record and make great advances in understanding many diseases – not just the common ones, but also the rare ones."

    Currently, Kaiser Permanente Research Bank is the second largest biobank in the U.S. (and the largest non-governmental biobank).

    "About 5 percent of people in any healthcare system will be diagnosed to carry one or more of what are called clinically actionable diseases, meaning something can be done about their genetic variant and disease condition," said Aziz.

    Many people have a genetic disease that has not been diagnosed and is not being managed properly because even the doctors don't know it's there.

    "Through our biobank participant sequencing," she said, "we are able to identify the ones who have these undiagnosed disease and return it to the patient and the clinical care delivery site so it can be managed right." 

    Aziz said the biobank program is open for collaboration with other healthcare institutions. You can learn more at the HIMSS Learning Center webinar: How Genomic Data Banks Are Enabling Progress in Precision Medicine.

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    At Kaiser Permanente, an EHR-linked biobank is opening new avenues for treatment and opportunities for other health systems to collaborate.

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    Malpractice claims for errors caused, all or in part, by electronic health records have risen significantly, according to a report from The Doctors Company, a physician-owned malpractice insurer. The study offers some useful tips to help providers protect against that risk.

    There were just two claims for which EHRs were either the cause or (more likely) a contributing factor between 2007 and 2010, according to report. From from 2011 through the end of 2016, however, there were 161.

    The new study examined more than five dozen of those claims and found a wide array of factors – some related to technology and system design (drop-down menus, templates, alerts) and some having to do with human error (lack of training, inappropriate use of copy-and-paste) – contributing to the alleged medical errors.

    [Also: Amid surge in malpractice lawsuits, EHRs often targeted in litigation, attorney says]

    "Our approach to studying EHR–related malpractice claims began by reviewing plaintiffs'/ patients' allegations, giving us insights into the perspectives and motivations for filing claims and lawsuits," wrote David Troxel, MD, medical director at The Doctors Company and the study's author.

    "We then looked at patients' injuries to understand the full scope of harm. Physician experts for both the plaintiffs/ patients and the defendants/physicians reviewed claims and conducted medical record reviews. Our clinical analysts drew from these sources to gain an accurate and unbiased understanding of actual patient injuries. We identified factors that led to patients' injuries, and physician reviewers evaluated each claim to determine whether the standard of care was met."

    
The report found that system factors in the EHR itself – poor integration, suboptimal design and UX, failures of alerts and alarms – were up 8 percent since the last time The Doctors Company did a similar report in 2015.

    Encouragingly, however, factors that might be attributable to user error – such as data entry errors, alert fatigue and misuse of copy-and-paste – decreased 6 percent.

    To help maintain that trend, the study outlined a series of risk mitigation strategies that physicians and clinicians can employ to help avoid malpractice claims, reduce the chance of errors and improve patient safety.

    Here are a few of things it suggests providers keep in mind.

    Be aware that physicians are the ones responsible for the data to which they have access. "Review all available data and information prior to treating a patient," Troxel wrote. "The healthcare setting, accessibility of data, and acuity of the patient's situation and condition will dictate what will be considered reasonable by a court."

    Be careful with e-prescribing, which is useful but offers many opportunities for error."Make sure you adhere to any alerts within the e-prescribing module of the EHR and document any actions taken," he wrote.

    Alert fatigue is a problem, but physicians could be liable if they don't follow an alert that could have prevented an adverse event."Do not disable or override any alerts in the EHR. Discuss alert fatigue issues with your organization's IT department or your EHR vendor," according to the report.

    Be careful with copy-and-paste."Avoid copying and pasting except when describing the patient's past medical history," wrote Troxel. "As with handwritten records, make sure your documentation is relevant, objective, and current."

    Stay aware of history & physical and procedure notes, which often autopopulate from older notes or templates."Contact your organization's IT department or your vendor if you notice that the autopopulation feature causes erroneous data to be recorded," he wrote. "If the autopopulated information is incorrect, note it in the record and document the correct information."

    Metadata is often as important as the notes logged in the EHR."It is important to remember that all physician interactions with the EHR are time-tracked and discoverable," according to the study. "As with paper medical records, notes written after a patient interaction should include the time of the interaction to avoid any suggestion of inaccurate or false information."

    Be careful with entry errors related to drop-down menus or other automatic features. "Erroneous information, once entered into the EHR, is easily perpetuated and disseminated. Review your entry after you make a choice from a drop-down menu."

    Point-and-click lists, autofill, templates and other canned text can often be overlooked by consulting physicians."Utilize your EHR's tracking function to ensure that consults and tests are completed, returned to you, and communicated to the patient," wrote Troxel. "When possible, enlist specific staff in your practice to monitor tracking."

    Don't share passwords, and stay vigilant about cybersecurity. "Staff should not be allowed to use the physician's password to review, update, or sign off on lab and imaging results. Allowing this type of activity could result in a report being filed without the physician seeing it."

    Even if an error can be traced to bad EHR design, vendor contracts often have "hold harmless" clauses that try to put liability onto physicians. "Keep in mind that some insurance policies may exclude coverage for product liability and indemnification of third parties. In addition, vendors and users typically settle disputes out of court with 'nondisclosure' clauses that prevent open discussion of the patient safety issues involved," wrote Troxel.

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    System factors in the EHR itself – poor integration, suboptimal design and UX, failures of alerts and alarms – were up 8 percent since the last time The Doctors Company did a similar report.

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    Medsphere Systems and Stockell Healthcare Systems will merge, uniting under one banner Medsphere’s subscription-based electronic health record system and Stockell’s suite of revenue cycle management tools. The transaction is expected to officially close later this month.

    Stockell will become a division of Medsphere and continue to use the Stockell name. Medsphere and Stockell are well acquainted through previous implementations but now will work together more closely.

    This news follows other recent revenue cycle company mergers. Revenue cycle management tech companies Navicure and ZirMed are merging into one company. The combined entity will market its suite of analytics-driven solutions to hospitals, health systems and ambulatory services organizations, including physician practices, with the goal of improving financial performance.

    [Also: Running list: 2017 health IT mergers and acquisitions ]

    And Allscripts 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.

    Medsphere and Stockell said the future is in the cloud. This past summer, Medsphere initiated the company’s cloud strategy starting with Southern Inyo Hospital and continuing that delivery model for other clients. Stockell provides InsightCS and related services to clients via its RCM Cloud hosted service.

    “We’ve collaborated several times on previous implementations, so this really seemed like a natural and very beneficial evolution of the relationship,” said Medsphere president and CEO Irv Lichtenwald. “The integration of OpenVista clinicals and InsightCS revenue cycle has already created a system that dramatically improves operational efficiency and the bottom line for our clients. We’re confident that subscription-based pricing and improved billing through an integrated RCM system will mitigate the financial impact of a large healthcare IT purchase.”

    Medsphere’s OpenVista EHR was initially derived from the U.S. Department of Veterans Affairs VistA system. Since its founding, Medsphere has systematically reduced dependence on VistA by significantly enhancing the system using more modern technologies, including mobility, improved patient documentation, population health and behavioral health modules, the company said.

    Stockell’s InsightCS system features a menu of options for managing key revenue cycle touch-points, including patient engagement, registration, scheduling, billing, collections, business analytics and reporting, the company said.

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    The combination of Medsphere’s EHR and Stockell’s revenue cycle management in the cloud will be offered through a subscription service payment model.

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    Washington, D.C.-based Children’s National Health System on Wednesday won a HIMSS Enterprise Davies Award for its pediatric concussion care initiatives. 

    “This recognition represents over 10 years of hard work from hundreds of staff here at Children’s National,” said Brian Jacobs, MD, who serves as CIO and CMIO at Children’s National. Jacobs added that the wide-ranging initiative included people, processes and technological innovations alongside research and education, both in-house and among children and their families. 

    [Also: Stanford Children's Health, Lucile Packard Children's Hospital Stanford win Davies awards]

    The HIMSS Davies program honors hospitals and systems that put health IT, including electronic health records of course, to improve care outcomes. 

    To earn the award, Children’s National Health System demonstrated innovative use of real-time quality and patient safety data for both clinicians and pediatric patients’ families. The hospital incorporated CT scan decision support rules into its EHR, for instance, which slashed CT scans by 44 percent and cut costs more than $875,000. 

    Additionally, by transitioning from the more traditional approach of clinicians dictating notes that then go through a time-consuming transcription into voice recognition technology for notes in speciality clinics, Children’s National was able to not only make those notes immediately available to all doctors on a patient’s care team but also eliminate a lot of the expense of transcribing them in the first place. 

    Jonathan French, director, Davies Award of Excellence Program at HIMSS, said that Children’s National earned the award by demonstrating “excellence through efforts to increase patient engagement and improve patient outcomes, through their health IT optimization for pediatric concussion care, in addition to various other care initiatives.”

    HIMSS will recognize Children’s National Health System at the HIMSS18 Awards Gala at Wynn Hotel Las Vegas on Thursday, March 8, 2018. Tickets are available through the conference registration form.

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    CIO Brian Jacobs says the award is the culmination of a decade’s worth of effort by hundreds of Children’s National employees, IT and otherwise.

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    Great Lakes Health Connect, a health information exchange covering much of  Michigan, is upgrading its referral capabilities by incorporating information about social determinants of health into its available data.

    More and more recently, the healthcare industry is recognizing that tackling those complex geographic, socioeconomic and behavioral factors are a key component to making population health management work.

    [Also: Social determinants of health and the $1.7 trillion opportunity to slash spending]

    To make some of that data available for some of the 9 million patients at the 129 hospitals and 4,000-plus ambulatory sites that connect to it, GLHC has enlisted Alpharetta, Georgia-based startup Holon Solutions, which develops patent-pending data exchange and decision support technology.

    The aim is to provide more effective care while also meeting the goals set by Michigan's State Innovation Model, which has established a series of standards for providers managing Medicaid patients, officials say.

    Holon says its CollaborNet technology will help integrate clinical and social determinant data, present information in via intelligent alerts within clinicians' existing EHR the workflow. The tool will also allow care providers more easily refer patients to community groups that could help them address social health issues such as transportation or housing.

    [Also: AMIA presses FCC on broadband access as a health issue]

    When a patient's electronic health record is opened, the Holon tool senses it and begins searching other data sources for supplementary data associated with that patient, company officials say. The analytics tools examines the records and relays pertinent data with an appropriate alert in the top right corner of the clinician's workflow.

    The alert can be clicked away or opened for further information and potential intervention. The tool can show coding or risk-adjustment opportunities, reveal gaps in care and identify members of specially-managed populations, officials say.

    [Also: Karen DeSalvo lays out vision for 'Public Health 3.0,' focuses on social determinants of health]

    "Holon takes the sea of data and makes it very relevant to a specific patient and his or her needs," said Doug Dietzman, executive director at GLHC, in a statement. "This is critical because our users are looking to us to help them solve their very local problems. We want to constantly anticipate answers to, 'How do we advance the care and experience for this patient in front of us today?' and 'How can we be more intuitive and make providers' lives easier?'"

    "We've tailored our product's referral functionality for GLHC's mass deployment, to allow physicians to refer patients seamlessly not just to other physicians, but to community organizations that assist with social health needs," added Holon CEO Bryant Castleton. "We're looking forward helping make Michigan a healthier state."

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    The EHR is a mission critical application. Even minimal downtime can have a significant impact on your clinical operations and, ultimately, your organization's bottom line. This paper shows best practices to stay current with Epic guidelines.

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    The EHR is a mission critical application. Even minimal downtime can have a significant impact on your clinical operations and, ultimately, your organization's bottom line. This paper shows best practices to stay current with Epic guidelines.

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