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    It's a fine line, engaging patients through portals while placing security as a high priority. As this paper shows, combining the right technology and clear communication is an effective path to both safer data and steadier patient confidence.

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    Patient Portals: Balancing Patient Engagement and Security
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    It's a fine line, engaging patients through portals while placing security as a high priority. As this paper shows, combining the right technology and clear communication is an effective path to both safer data and steadier patient confidence.

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    Cloud-based EHR vendor athenahealth confirmed plans to layoff 9 percent of its workforce on Thursday and that it is simplifying its structure to be leaner and more responsive.

    The company also noted in a filing with the Securities and Exchange Commission that its top line revenue is up 11 percent while earning dropped 7 percent year over year.

    “Our board of directors and management team have been conducting a strategic review of our operational and financial strategy, leadership and governance to drive increased levels of profitable growth and enhance shareholder value,” an athenahealth spokesperson said. “As part of this effort, we announced [to our employees] earlier today a new organizational design.”

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

    The leaner, more simplified structure is designed to enable the EHR vendor to be more responsive to client needs and is expected to improve employee engagement by increasing efficiencies, streamlining workflow and enhancing accountability, the spokesperson said.

    “It will result in a reduction to athenahealth’s total workforce by approximately 9 percent,” the spokesperson added. “We expect that the majority of these workforce reductions will be completed by the end of 2017.”

    When markets closed on Thursday, athenahealth said it was announcing “the company’s sustained momentum and strong ability to drive financial and operational results for clients across the community hospital market.”

    It went on to describe clinical successes, stating that as part of its national network of 106,000 providers and 102 million patients, athenahealth supports a growing list of 56 community, rural and critical access hospitals. Those clients that have been on athenaNet for a full year are achieving on average cash collections of 5 percent over baseline, the company said.

    [Also: Epic rivals say they are making the CHR switch, too]

    “One in three rural hospitals is at financial risk, which says to me they need a partner to help them scale innovation as well as eliminate underperforming processes and traditional software tools,” said Kyle Armbrester, chief product officer at athenahealth. “We’ve been able to successfully tap into a market underserved by current healthcare IT vendors and retain 95 percent of hospital clients who we’ve brought live onto our network.”

    It’s not clear if all of the layoffs came from the Watertown headquarters or if some of them occurred at other U.S. or international offices. According to securities filings, athenahealth had 5,305 employees as of July.

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

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    Epic ranks at the top of enterprise vendors offering EDIS – Emergency Department Information Systems, according to a September 2017 report from research firm KLAS.

    KLAS points to Epic’s consistently excellent support, relationships and customer satisfaction among the factors.  

    “Organizations using Epic have significantly higher overall satisfaction than those using other enterprise vendors, despite lower workflow satisfaction compared to customers of best-of-breed vendors,”

    [Also: Emergency departments drop best-of-breed technology]

    It’s not always a positive experience.

    Customers complain about excessive and repetitive clicking, back and forth navigation and upgrades that add more clicks.

    However, KLAS notes users admit that these steps/clicks have helped improve patient safety.

    Epic’s main competitor, Cerner, does not fare as well as its rival, having fallen short on the usability front, according to KLAS.

    “Cerner has made fewer impactful usability improvements than any other vendor,” KLAS researchers wrote.

    “While Cerner continues to gain new ED customers and delivers a better workflow for ED physicians than MEDITECH or Allscripts, researchers wrote, “users feel hampered by inconsistent training, reactive support, and a lack of the kinds of innovation that could improve physician satisfaction.”

    Cerner has made efforts to reduce clicks through two tools meant to streamline documentation within provider workflows – Dynamic Documentation and PowerNote – but respondents report still being dissatisfied with the inefficiency and burden of clinical documentation.

    Allscripts users feel hampered by inconsistent training, reactive support, and a lack of the kinds of innovation that could improve physician satisfaction, KLAS said.

    Best of breed vendors are showing their mettle, according to KLAS.

    “For years, best-of-breed vendors have shown that it is possible to deliver an EDIS that meets provider organizations’ needs and expectations for usability and functionality,” KLAS notes.

    But the market is shifting to enterprise vendors. KLAS suggests those vendors will have to step up their game.

    “As the market shifts and enterprise vendors play a larger and larger role, they will need to keep up with the standards set by the high-functioning, best-of-breed solutions,” KLAS writes.

    For example, Wellsoft has been the Emergency Department Best in KLAS winner for nine out of the past 10 years, delivering “an extremely consistent performance and one of the best support experiences in healthcare IT.”

    T-System and Picis have also had consistently high levels of satisfaction in all areas KLAS measures.

    As for Meditech, it’s dealing with “workarounds, system lag time, a confusing layout, and functionality geared more toward an inpatient environment.”

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

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    Epic ranks high, Cerner falls short in latest emergency department information system KLAS rankings
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    Epic ranks high, Cerner falls short in latest emergency department information system KLAS rankings
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    While many vendors earned high marks, they all seem to have ‘too many clicks’ in the eyes of their users

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    Santa Clara Valley Medical Center earned the Stage 7 designation of HIMSS Analytics Electronic Medical Record Adoption Model.

    Also known as EMRAM, HIMSS Analytics program recognizes hospitals that use health IT to improve patient outcomes.

    SCVMC CEO Paul Lorenz said that Stage 7 goes beyond just implementing technology.  
    “It is about using the technology in a meaningful way to provide quality care and improve patient outcomes,” Lorenz added. 

    To that end, SCVMC implemented a new electronic health record and analytics tools to construct processes for various specialists to exchange consult requests and feedback with referring providers.

    The payoff? A 15 percent decrease in visits that shortened wait times across departments and, in turn, enhanced the patient experience.

    “Santa Clara Valley was able to enhance the patient experience with reduced wait times and quicker follow-up care,” said Philip Bradley, regional director of North America at HIMSS Analytics.

    SCVMC chief medical officer Philip Strong, MD, added that the whole point of creating a better experience is to improve outcomes.

    “Our medical staff has shown they understand the value of a comprehensive electronic medical record, and that they use the analytics the system provides to improve care, quality, safety, and efficiency,” Strong added.

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

    Santa Clara Valley Medical Center will be recognized at the HIMSS18 Awards Gala taking place on Thursday, March 8, 2018, in Las Vegas. 

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

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    Enhanced patient experience earns Santa Clara Valley Medical Center EMRAM Stage 7 from HIMSS Analytics
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    Enhanced patient experience earns Santa Clara Valley Medical Center EMRAM Stage 7 from HIMSS Analytics
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    The hospital uses its EHR, analytics and associated IT to foster communications between departments, decrease visits and shorten wait times.

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    Athenahealth CEO Jonathan Bush struck several belt-tightening notes Friday morning during the company’s third quarter call with analysts. The earnings call came after the company cut 9 percent of its workforce, or nearly 500 jobs, on Thursday.

    The company’s top-line was up 11 percent for the third-quarter ended September 30 while earnings, on the other hand, fell by 7 percent. 

    “We are changing the way we work to become a more nimble and efficient organization while directing investments to our greatest return opportunities,” Bush said. “We’ve tightened our controls to ensure that our expenditures fall within the constraint of profitability and business goals.”

    Bush explained that the company identified cost-savings opportunities. Over the past few months, he said, athenahealth built the comprehensive plan to achieve those savings and also identified other efficiency opportunities.

    Today, the company is poised to achieve $100 million to $115 million in pre-tax expense savings by the end of 2018, he added. The savings will come from two broad categories: Discontinuing low yield, or redundant operations and activities and reducing managerial layers.

    Bush said the work of streamlining operations began Thursday with the job-cutting announcement and added that the company also may trim sales and marketing teams by the end of 2017.

    Bush said athenahealth would reduce its real estate footprint and optimize its assets. The company will close offices in San Francisco and Princeton, N.J. It will rent out excess capacity at remaining offices. Athenahealth will also sell the company jet. 

    Bush, however, did not mention the 387-acre Maine resort the company purchased in 2011 as an employee-training and client-entertainment facility.

    “This further reflects our changing mindset as we evolve the way we do business,” he said, adding it would not be a “one-time only exercise,” but rather a fundamental change in the way we’re managing the business. Bush added that the company also would be “right-sizing sales and marketing for today’s market condition. Most of these measures would be completed by the end of 2017, he said.

    Bush announced athenahealth would reduce its real estate footprint and optimize its assets. The company will close offices in San Francisco and Princeton, N.J. It will rent out excess capacity at remaining offices. Athenahealth will also market and sell the company jet,

    He did not mention the 387-acre Maine resort the company purchased in 2011 as an employee-training and client-entertainment facility.

    “This further reflects our changing mindset as we evolve the way we do business,” he said, adding it would not be a “one-time only exercise,” but rather a fundamental change in the way we’re managing the business.

    In emphasizing the positive this morning Bush highlighted the company’s hospital business.

    As part of its national network of 106,000 providers and 102 million patients, athenahealth supports 56 community, rural, and critical access hospitals. As Bush sees it, it’s a market ripe for growth.

    Today hospitals live on athenahealth for a full year are achieving on average cash collections of 5 percent over baseline.

    “Today, athenahealth benefits from a solid operating foundation. We are the most universally connected healthcare network in the country,” Bush noted. “The value we offer to our clients is as strong as ever. We are changing the way we work to become a more nimble and efficient organization while directing investments to our greatest return opportunities.”

     “We’ve tightened our controls to ensure that our expenditures fall within the constraint of profitability and business goals, he said.

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

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    CEO Jonathan Bush says plans are underway to curb as much as $115 million in spending by the end of 2018.

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    The eHealth Initiative published a new research uncovering the reality that only 9 percent of healthcare providers are currently compliant with the Office of the National Coordinator for Health IT’s 2015 Edition for EHR certification. 

    ONC’s 2015 Edition Health IT Certification Criteria (known as the 2015 Edition) required health IT to demonstrate it can provide access to Common Clinical Data Sets (i.e. date of birth, race, ethnicity, vital signs, medications, lab tests, care team members, immunizations, assessment and plan of treatment, etc.) via an application programming interface.

    [Also: List: 29 new products added to ONC's 2015 Certified Health IT database]

    The CMS’s Merit-based Incentive Payment System and Meaningful Use requirements for Stage 3 require making such APIs available to patients. Providers in these programs also are subject to new information blocking prohibitions.

    The eHealth Initiative asked 107 health IT executives how far along they were in complying with the new patient access requirements and discovered only 9 percent were fully compliant with the ONC’s 2015 EHR certification (no longer required for 2018) through products that enable open APIs.

    Forty-one percent of the 107 execs said they are in the process of implementing technology, 13 percent are evaluating options/are in the planning phase, 12 percent are waiting for guidance from IT vendors, 7 percent are aware of requirements but have not started, 3 percent are unaware there were new requirements and have not started, and 15 percent are not sure, the survey found.

    On the subject of patients sharing more information, the eHealth Initiative dug in deeper. When asked if more patients are asking to see their data, 35 percent of healthcare executives responded they’ve seen a major or moderate increase in requests, 40 percent said a minimal increase and 20 percent said no change, according to the survey.

    When it comes to patients wanting to provide information in addition to what is in their EHR record, 27 percent of survey respondents reported a major or moderate increase, 35 percent said a minimal increase and 33 percent said no change.

    Patients want to share all kinds of information with other clinicians. According to the survey, 68 percent of patients wish to share lab data, 56 percent imaging results, 51 percent prescription information, 36 percent blood pressure readings, 34 percent diabetes monitoring data, 27 percent other provider reports, 16 percent weight readings, 15 percent medication adherence data, 12 percent wearable data, and 8 percent food diaries.

    So what is the impact of increased access to patient information? The providers surveyed point to a variety of factors. 75 percent of respondents said increased access improves patient engagement in their care, 65 percent improves quality of care, 62 percent improves patient satisfaction, 38 percent reduces costs, 21 percent increases costs, 5 percent reduces quality of care, 2 percent reduces patient satisfaction, and 1 percent reduces patient engagement in their care, the survey found.

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

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    Only 9 percent are fully compliant with ONC’s 2015 EHR certification, according to a new report from the eHealth Initiative.

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    Athenahealth CEO Jonathan Bush last week announced the company would cut 9 percent of its workforce and reduce spending by $115 million to put the recently besieged cloud-based company back on track. In the company’s earnings call, Bush detailed the changes and gave some perspective on the road ahead for the vendor.

    Here are seven of his most salient quotes:

    On the company’s layoffs 

    “I've used the term metamorphosis for a couple of calls now. Q3 contained the most painful stage of our metamorphosis. Parting ways with 9 percent of our employees is parting ways with 100 percent of the employees that we attracted and retained and trained and employed for the first decade of athenahealth's existence.”

    On the promise of EHRs

    "There is a thesis that as medical records become more connected, duplicate procedures and tests decline. We can't point to a smoking gun there. These are just the macro ideas. But right now, we can't point to numbers that say – that prove – those theories."

    On the future

    “We are in a really interesting sort of period as a nation and as a healthcare system, we still don’t really know what the law of the land will be. We are coming off a giant sugar hangover from the Meaningful Use Program, but the idea that maybe this Internet thing is not going to be so big after all is an absurdity.”

    On the effect of Elliott Associates

    “I think this process – and I’ll say including the arrival of our activist investor – has really caused all of us, all of us, not just all of the management team, to look at the company through different eyes.”

    On the good news

    “So the customer service team has done an extraordinary job this year. Satisfaction with calls, answer time on calls, first call resolution of the calls, are at all time Athena highs and we're extremely proud of that.”

    On interoperability

    “Fundamentally, every hospital in the country in order to prosper must be able to interoperate with really nationally – at least super regionally – with entities that they don't control. We are by far the leader in that, even with our own warts, which frustrate us, and so we think that history is on our side there.”

    On remaining staff

    “My primary concern in this process was one of cultural impact. Would this demoralize? Would this de-motivate or would this inspire? And I am extremely pleased and confident that the answer is the latter. We have an extraordinary collection of colleagues who are in this for the mission and they want that mission even at the expense of hard decisions.”

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

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

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    The EHR company’s CEO says he layoffs stung but admitted the presence of an activist investor has led the vendor to scrutinize its performance.

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    Beth Israel Deaconess Medical Center CIO John Halamka, MD, has written and presented often over the past few years about his wife Kathy's cancer treatment and the ways precision medicine techniques have helped guide her care plan.

    In a recent HIMSS Learning Center webinar, he shared some lessons learned from a recent chapter in that journey and offered some optimistic words about the timeline for improving the delivery and reimbursement of personalized treatments.

    In Halamka's telling, effective precision medicine entails and requires much more than just the genomic science most commonly associated with the term. It depends on patient and family engagement, social determinant factors, easily interoperable clinical decision support tools and more.

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

    For one example, he cited a letter Kathy Halamka received letter from her insurer, the highly rated Harvard Pilgrim, explaining that it was suddenly denying coverage for the current dosage one of her ongoing estrogen-suppressing drugs because it had found an old research paper that showed a dosage of half that amount would be equally as effective.

    Halamka, who will be speaking Monday at the HIMSS Big Data and Healthcare Analytics Forum in Boston, wrote extensively about the episode on his blog this past month.

    When asked, Harvard Pilgrim conceded that it hadn't consulted Kathy's records, protocols or preferences to determine whether the choice was right or justified, and hadn't reviewed anything about Kathy's personal characteristics that "would suggest that potentially 22.5 mg was the right dose," instead of the 11.25 mg it was willing to reimburse.

    Partly perhaps owing to his position as one of the most recognizable figures in healthcare, Halamka was able to consult with Harvard Pilgrim at a high level and asked it to consider embracing a more evidence-based approach.

    "Payers and providers need to relate to each other using an evidence base to connect the two so we're delivering the right care for quality and outcomes," he said. "In many parts of the country payers and providers don't like each other very much. And the notion of exchanging clinical data from provider to payer for care management and precision medicine is still a psychology problem, not so much a technology problem."

    Thankfully, Harvard Pilgrim is one of the most forward-thinking health plans in the U.S. It agreed, after further discussion, to stop sending letters like the one Kathy received, said Halamka.

    Instead, future changes in approved treatment plans would be explained by saying, "We have, through evidence, determined that you might be on a medicine that's not optimal for you," he said. "It might cause too many side-effects, might not be as effective as it could be."

    There would be phone calls, communications with care teams, reviews of patient records, their protocols and perhaps their genetic makeups. If it's decided on both sides of the provider-payer equation that there might be a better dosage, the patient might eventually get an e-prescription from the care team that explaining why it's being changed.

    A process like that incorporates the essential elements of precision medicine, said Halamka: "Who is the patient, what are their preferences, what is their genetic makeup, what is the evidence that suggests that one treatment is better than another for that individual?"

    We're getting there, but "it's still early" and it may be some time before "we exactly get it right," he said. But perhaps not as much time as some think.

    Imagine if ...

    "Here's how it should have worked," said Halamka. "Imagine if, in the EHR, because clinicians hate going to some website or separate application, when the clinician goes to order the information, it's sent to a cloud-hosted decision support provider," along with some minimal amount of patient information that might be relevant: age and gender, diagnosis, some lab values.

    "Then the decision support service provider returns some pleasing answer," he said. "'For this particular patient this particular dosage will be maximally effective with the fewest side-effects. Instead of having to do this in a post-coordinated fashion, six months after the patient is already on a protocol, you're doing it as the order is initiated, which gives the opportunity for the patient, doctor and decision support to all be in the same room at the same time.

    If that sounds too good to be true, it's much closer to being common practice that many might assume.

    "Lest you think that is something five years hence," said Halamka, "as we're starting to see, more and more of our EHR vendors – Cerner, Epic, Meditech, athenahealth, eClinicalWorks – are embracing the idea of using the FHIR standard to connect to third-party applications and knowledge sources."

    He pointed to the FHIR-based CDS Hooks standard, which is "exactly designed for the EHR to contact some external knowledge provider and consume the result inside the EHR workflow."

    The clinicians get guidance showing possible treatment choices and objective rankings of safety, quality, efficiency, cost, and availability. And then the clinicians and their patients have a discussion and, via shared decision-making, develop a care plan."

    And array of open-source apps are increasingly showing their worth when it comes to communicating care plans to the patient and relaying patient-generated healthcare data back to the provider, of course, and that is where the energy will be on this front, said Halamka.

    "EHR vendors are doing great – they're doing everything we need for regulatory compliance and revenue cycle," he said. "But they are not likely to be the place where radical new innovation occurs, in AI and matching learning, or the ability to provide this very evidence-based skinny downset of actionable items for clinicians at the point of care," he said.

    Halamka predicts that we'll be seeing much more commonplace "production-level FHIR exchanges" between EHRs and cloud-hosted clinical decision support providers "in the next 12 months."

    Hurdles ahead, but big innovations are coming

    In the meantime, he sees other innovations sprouting that will enable new momentum toward more personalized treatment plans.

    For instance, he predicted that consensus will finally soon start to emerge on nationwide patient-matching strategy. That will be essential "if we're going to deliver precision medicine as I've described – data about you in a more continuous rather than episodic fashion, and knitting it together," said Halamka.

    "I do think that in the next year, you'll see not a national identifier, but a strategy, guidelines" – it could be biometrics, it could be any number of different approaches being workshopped by an array of groups such as CHIME, Pew Charitable Trusts, the CommonWell Health Alliance – that will enable patients to be easily identified across care settings.

    Accountable care, he said, is helping to force that "urgency to change," said Halamka, and "the drive to value-based-purchasing will help accelerate the drive to precision medicine."

    Add to that a healthcare landscape that figures to be (relatively) unburdened by federal regulations after a decade dealing with HITECH, ICD-10, the HIPAA Omnibus, ACA, etc.

    "I think we can say the next three years will probably have fewer legislative and regulatory efforts," said Halamka. "That means the private sector are going to guide where we're going forward. And it gives us the breathing room to drive the precision medicine innovation I've been talking about."

    There are challenges ahead, of course: The tools patients and families use to find their way around the care delivery system – portals, primarily, are suboptimal, to say the least. And on the provider side, clinicians are hardly much more enamored of their EHRs. The infrastructure for information exchange also, clearly, leaves lots to be desired.

    But Halamka says he's optimistic about the prospects of better integrating care plans and clinical pathways into the tools of the trade (EHRs, PHRs and apps) "so the patient, the family and the doctor all have a single playbook to work from."

    That's the name of the game, he said. It's going to "reduce errors and cost, include appropriate peer-rated evidence, result in clear action for the care team."

    And in a value-based work, "it's a team-based sport," said Halamka. "It isn't just a PCP and a patient. It's going to be the family, the nurse, the pharmacist, the social worker. All folks working together it's really important you have a common care plan for disease state and patient to work against."

    Progress is being made at Beth Israel Deaconess Medical Center, he said, which is developing technologies and strategies to enable more personalized interventions – such as a pilot to deliver to patients' phone, in real time, actionable items for their specific disease state and conditions, and then allow them to report back on their progress using an array of IoT devices.

    BIDMC is an innovation outlier – it's the last hospital in America to self-build its core electronic health record – but "I can assure you that Epic and Cerner are busy at work creating very similar functionality," he said.

    "This is the kind of integration with precision medicine care planning, workflow with doctors patients and families that we all want," said Halamka.

    "I believe that the promise of precision medicine is real," he said. "And our experience with patient family engagement, the emerging promise of machine learning and IoT connectivity, combined with evidence, will get us there – not in five years, but in one."

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

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    Halamka: Decision support, care management key to accelerating precision medicine
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    The Beth Israel Deaconess Medical Center CIO says tailored treatment plans could be here soon with more widespread FHIR exchanges enabling easier access to cloud-based CDS insights.

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    BOSTON – The healthcare industry is amassing more data than at any time in history but much of it is running on top of legacy technology.

    “The average hospital generates 665 TB a year,” said John Quackenbush, a professor of Biostatistics and Computational Biology at the Dana Farber Cancer Institute and Harvard School of Public Health.

    Speaking at the HIMSS and Healthcare IT News Big Data & Healthcare Analytics Forum on Monday, Quackenbush added: “We’re awash in data -- the challenge is what to do with it.”

    Vik Nagjee, CTO of Pure Storage, said that many hospitals still operate with legacy IT and pointed to one integrated delivery network that maintains a whopping 18,000 applications.  

    To that end, Nagjee said hospitals should evaluate where they are now in order to move forward into the world of big data, analytics, AI and machine learning

    “Look at any other industry,” Nagjee said. “Finance is risk-averse and they figured out ways to not have such fragile infrastructures and applications. We need to come together to make this happen in healthcare.”  

    In addition to modernizing IT infrastructure wherever possible, hospitals also have to overcome the challenges of integrating data from a variety of existing and emerging sources -- and today’s crop of electronic health records can be problematic.

    “EHRs are not designed to be a strategic repository to drive better care, they’re designed to optimize billing,” said Adrian Zai, MD, research director of Partners eCare. “How to connect external data? We all know EHRs are not good at it. Finding ways for all data to work together is one of the challenges.”

    Quackenbush said healthcare organizations have to focus on delivering the right data, including current information about the state of a patient in front of clinicians as well as outcomes data.

    And he recommended not falling for the common misconception that simply throwing a lot of shiny new technology at the problem because biology and healthcare are hard.

    “The goal is to turn data into information, into knowledge, and ultimately into actions and outcomes,” HIMSS Director of Payer and Life Sciences Shelley Price said.  

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


     Read our coverage of HIMSS Big Data & Healthcare Analytics Forum in Boston.
    ⇒ Change management is IT's greatest challenge in delivering needed innovation
    ⇒ It takes a lot more than analytics to make population health work
    ⇒ Go figure: The key to big data is actually small data


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    Healthcare is swimming in data, but what to do with it?
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    Healthcare is swimming in data, but what to do with it?
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    It’s time to take stock of big data so we can move forward and turn it into knowledge, experts at the Big Data & Healthcare Analytics Forum say.

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    BOSTON – How can analytics help improve population health? Good data and smart use of information technology are important, said Tom Scornavacca, senior medical director, population health at UMass Memorial Health Care. But enthusiastic buy-in from care providers is essential.

    "No matter how good the data is, if you have providers who are tuned out disinterested or misaligned, it's hard to get the Titanic to turn," said Scornavacca, speaking Monday at the HIMSS Big Data and Healthcare Analytics Forum.

    UMass Memorial has notched some important wins in recent years, leveraging analytics tools to identify and intervene with the patients who need it most. From diabetes management to immunizations and beyond, it's been able to spot gaps and in care, find innovative ways to address them and, crucially, engage clinicians and care teams to intervene with positive steps for better health.

    [Also: Change management is IT's greatest challenge in delivering needed innovation]

    For instance, as part of the American Medical Group Associations' Analytics for Improvement collaborative, UMass was able to increase vaccination rates across all age groups over the course of a year. It required an all-hands-on-deck approach that entailed a lot more than a snazzy data dashboard.

    The health system incorporated immunizations interventions into its existing pop health management and quality improvement efforts, using care registries to identify evidence-based gaps for primary care panel; employed outreach coordinators to help schedule patients for care when it was required, and used performance improvement facilitators to work alongside physicians and practice staff on workflow redesign.

    On the technology side, UMass made use of clinical decision support at the point of care and deployed performance reporting tools and customized analytics that integrated clinical and claims data.

    "Providers want actionable data," said Scornavacca. "The more predigested you can get the data, the better."

    It's important to show, not just tell. As part of its larger population health management efforts, UMass creates action plans for discrete periods of time and then uses data to show its providers how certain quality measures looked before and after that window.

    It also developed a patient risk matrix, a quadrant that groups populations according to the urgency required for interventions, from healthy (a focus on wellness and prevention) to rising risk (may need more complex risk management) to chronic disease to urgent illness.

    But effective and lasting population health and quality improvement efforts need much more than a series of charts and graphs.

    Scornavacca said 33 percent of patients in the "rising risk" corner eventually end up in the "urgent" top right, requiring complex and resource-intensive intervention.

    "You have to figure out who will bubble up to the top and that's where we devote our time and energy," he said.

    Pop health is hard work: "You can't just rip the Band-Aid off and say, 'Take care of readmissions,’" said Scornavacca. It requires intensive interventions from care teams, "windshield time" on the road to visit the patients most in need, alignment with an array community-based resources, close collaboration in the hospital, smart use of sophisticated analytics tools and, often, disruptive changes to workflow and well-established routines.

    Buy-in from all stakeholders comes with huge rewards, of course. But "if you don't have provider engagement, this becomes a very difficult task," he said.

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


     Read our coverage of HIMSS Big Data & Healthcare Analytics Forum in Boston.
    ⇒ Change management is IT's greatest challenge in delivering needed innovation
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    BOSTON – To successfully leverage healthcare analytics, it might be time to break big data down into smaller increments to better transform the information into knowledge.

    “Small data will tell us more than all of the big data we have now,” said Optum Vice President Abbas Mooraj, speaking at the HIMSS Big Data and Analytics Forum Monday.

    Providers should move away from the idea of big data and instead focus on the small nuances of data, the information can reveal actionable insights, said Mooraj.

    Dexter Braff, The Braff Group president, agreed.

    “The smart VC isn’t looking for a big solution, they’re looking for a tiny solution.”

    The idea, Braff explained, is to build a larger puzzle from each of these little pieces.

    To Adrian Zai, research director for Partners ECare, it’s the most effective way to leverage all of those tools to the market.

    “It’s a big market and there are a lot of tools out there,” said Zai. “In this era where we’re shifting from fee-for-service to value-based care, the solutions that target a specific outcome will have an edge.”

    For example, Zai said that predictive models can provide a very targeted intervention, but the solution is part of the bigger picture.

    “But whatever the solution you come up with, if it moves the needle in the right direction, it’s the right tool,” said Zai. “[Providers] all have unique problems, but you can can’t solve them with big, sweeping solutions. What they need is the little solution to move them to the next small step.”

    Leveraging technology in this way may be most effective, it’s not always simple. Zai said there are some big challenges facing providers when attempting to establish a big data platform, including that EHRs weren’t designed to be a “scientific repository to drive better care -- it’s designed to optimize billing.”

    “[EHRs] aren’t for channeling external data, but the problem doesn’t just lie with EHRs,” said Zai. EHR data is hierarchical or sequential, but big data is very different -- from the file types to schematics.

    “Finding ways to really have all of this data work together is one of the biggest challenges we have today,” said Zai.

    But while big data is often spoken about in big chunks, the direction the industry is heading in will break down the data siloes to create a shared data platforms.

    To Braff, this will be best accomplished by creating regional, closed systems that link up providers and payers, while incentivizing both. However, it’s possible to aggregate providers, but patients can move between systems.

    The challenge is with the payment models, said Braff. There have been a long list of ideas and emerging policies touted as the solution for transforming healthcare, like pay-for-performance, but not much has taken off as the payment methodologies aren’t right.

    “Health IT sits at the crossroads, at the very center if what’s necessary in order to facilitate care,” said Braff. “From an investment standpoint, it’s all based on the assumption that these new payment models will be rooted in our system.”

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


     Read our coverage of HIMSS Big Data & Healthcare Analytics Forum in Boston.
    ⇒ Change management is IT's greatest challenge in delivering needed innovation
    ⇒ Healthcare is swimming in data, but what to do with it?
    ⇒ It takes a lot more than analytics to make population health work


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    As Hurricane Harvey approached, an 8-bed East Houston hospital with an active ER had to decide whether or not it could remain open. This article shows how they weathered the storm and offers advice to other health facilities facing severe weather.

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    It will take 18 months for the U.S. Department of Veterans Affairs to launch the new Cerner electronic health record and another seven to eight years to transition the whole legacy EHR system once the contract with Cerner is finalized, VA Secretary David Shulkin, MD,  told the House Committee on Veterans’ Affairs on Tuesday.

    But some on the committee weren’t convinced of the timeline.

    "This isn’t a scientific analysis, but I have yet to see a VA budget for time or cost [not] exceeded," said Rep. Beto O’Rourke, D-Texas. "It usually goes beyond the budgeted time, beyond the budgeted costs."

    Shulkin’s response? “This is a new VA, congressman.”

    Just last week, the VA sent out a request for information to determine how best to achieve interoperability with community providers, as the agency is looking to expand its choice program to ensure all veterans are able to receive timely and quality care, Shulkin said.

    In addition, the VA has given “Congress a 30-day notification of our intent to negotiate a contract that would give us the true interoperability with the Department of the Defense,” said Shulkin. 

    “This is a total package, where that’s what we seek: real and full interoperability for veterans.”

    The contract with Cerner is expected to be finalized and announced by next month. The cost of the project has yet to be released. The DoD just went live with the final pilot site for its own Cerner EHR project at the Madigan Air Force Base this week.

    On Friday, the U.S. Court of Federal Claims dismissed the lawsuit made by CliniComp against the government, which claimed the no-bid contract awarded to Cerner by the VA was “arbitrary” and “lacks a reasonable basis.”

    The California-based EHR developer filed suit in August, and the case was dismissed based on jurisdiction. The judge’s opinion remains under seal.

    Twitter: @JessieFDavis
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    In this webinar, Ernest Sohn, chief data scientist in Booz Allen’s Data Solutions and Machine Intelligence group, will explain the work that went into developing a machine-learning system. And he will share lessons learned on how to best apply machine learning processes to clinical situations.

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    In this webinar, Ernest Sohn, chief data scientist in Booz Allen’s Data Solutions and Machine Intelligence group, will explain the work that went into developing a machine-learning system. And he will share lessons learned on how to best apply machine learning processes to clinical situations.

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    BOSTON – Though analytics technology is well-developed and widely deployed, putting those tools to work for better patient outcomes is still a big project as providers grapple with complex and sometimes competing priorities.

    At the HIMSS Big Data and Healthcare Analytics Forum on Tuesday, clinicians from two major health systems and an expert in data systems compared notes about turning troves of numbers into financial and operational improvements and – most importantly – better healthcare for their patients.

    One key factor in determining an organization's chances for analytics success has to do with their approach to the myriad problems that can be solved with data, said Joe Bluechel, vice president, data and analytics solution at Sirius, a consultancy that helps with technology and data systems integration.

    "A lot of it boils down to how you are organizationally aligned," he said. 

    Is your process an ad hoc one, reactive and marked by one-off requests to disparate challenges, for instance? Or are you able to take a more strategic view, deploying analytics as "competitive advantage to improve quality and costs and the patient experience?"

    How you answer that probably depends, in part, on how attuned you are to some of the finer points of how data models are put into practice, said Ken McCardle, senior director of clinical operations at Mount Sinai Health System.

    There are teams that create models and teams that operationalize models, said McCardle, and oftentimes those people have very different skill sets.

    "At my organization, for the data science and biostatistical analytics professional that are developing all these models, that operational world is sort of scary to them – it means you have to deal with IT and change management and applications and vendors and interfaces and all kinds of other different things," he said.

    On the other hand, those on the operational side have their own set of challenges.

    "It's another aspect of these model developments we have going on today: How do operationalize it?" said McCardle. "Who's keeping an eye on these models when you do the next (IT) upgrade? Did it break your new model? When you install a new device at the lab, does it send data to your system like you were expecting it to? There's a lot for us to think about, about how we operationalize these models."

    Another big variable has to do with where the demand for various analytics projects comes from:  Is it demands from the C-suite to find innovative ways improve the bottom line? Or is it more targeted project initiated by those on the clinical side? Each demands a different approach.

    "Sometimes the charge will come from an executive level, whether it's readmissions, or some other problem on a large scale, like supply chain," said Mark Poler, physician informaticist for enterprise data strategy at Geisinger Health System. "Other times it's clinician champions, who are focused on a certain area like heart failure or chronic lung disease or diabetes who provide the stimulus to create something new.

    "Then it becomes an interactive dance between those who are motivated to create and to use things and make them useful," he added, "and governance over what all the processes are that are in play and discovering that perhaps people in different parts of the organization that are doing similar things could do those things together and create something that's more reproducible and usable and modular, instead of a lot of little things that are hard to operationalize and support."

    That sort of "dance" is a critical thing to keep in mind when trying to chart lasting real-world changes from analytics projects, no matter what they might be, said Bluechel.

    "There's always a trade-off between organizational agility and quick wins, versus long-term charters that really have impact," he said. "Our organization focuses a lot of time and energy with our customers on where to start: What are the different dependencies on these different initiatives and what's the business value and impact."

    As they strive to show incremental wins from their data projects, more "self-aware" customers are able to identify their challenges, said Bluechel.

    "Everything we do has to be focused on foundational improvement," he said. "A lot of that is not a technology problem. Policy and process and compliance issues are also road-blockers."

    McCardle agreed. Although the excuses can be easy to grasp for – "my patients are so much sicker, my data is so much dirtier" – it's often not hard to realize that people and process are at the root of the problem.

    "Data is imperfect," said Poler. "There's always huge defects in the data. But it's what we got, we have to work with it."

    Add to that a fast-changing data and technology landscape, and the challenges become more acute.

    "The world has changed dramatically over the past 25 years," said Bluechel. "If you think about traditional data warehousing, and Kimball and Inmon philosophies about a centralized data repository, some of the best practices and universal approaches still hold true," said Bluechel.

    But with the explosion of new data in recent years – Internet of Things, social determ – the world has "morphed where you have to look at your data warehousing and analytics platforms truly as a distributed system," he said.

    "We talked a lot about logical data warehousing, and using that as a reference architecture and building common semantic layers across a wide variety of different sources and systems to organize and integrate that data in a logical fashion using things like data virtualization and some of the data discovery tools that can help with that. The days of being able to suck it all into the central repository, those days are dwindling."

    However the data is warehoused, an absolute must-have for effective analytics is good data visualization and UX, said Poler.

    "You can show people numbers all the time, and people fall asleep," he said. "But then you show them a picture of the gaps in the operating room and the senior administrators go, 'Gasp! We can't have that.' The picture is the thing that changed the impact of the data. It's the same data.
”

    "Eighty percent of the cost of an analytics solution is in data preparation: the ingestion, data quality and data organization," said Bluechel. "But organizations don't appreciate that value, because it's just the plumbing: 80 percent of the final impact is in the visualization. There's a reason they call it the final mile. You have to take that data and visualize it in a way that can be actionable."


     Read our coverage of HIMSS Big Data & Healthcare Analytics Forum in Boston.
    ⇒ Change management is IT's greatest challenge in delivering needed innovation
    ⇒ Healthcare is swimming in data, but what to do with it?
    ⇒ It takes a lot more than analytics to make population health work
    ⇒ Go figure: The key to big data is actually small data
    ⇒ Geisinger, Mount Sinai execs offer best piece of advice on succeeding with analytics


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    From just six founding EHR vendors when it was launched four years ago, the CommonWell Health Alliance now has more than 70 member companies whose expertise ranges far and wide.

    "It continues to astound me how diverse and all-encompassing our membership is becoming," said Nick Knowlton, CommonWell's membership committee chair, as the alliance kicked off its Fall Summit and Annual Meeting.

    [Also: Imprivata joins CommonWell Health Alliance to push interoperability]

    "This group of new members is no different," he added. "But one thing remains consistent across our entire member base – our passion for improving the accessibility and sharing of health data to improve clinical outcomes."

    The newest CommonWell members are:

    AdvancedMD, which makes cloud-based office software to ambulatory medical practices, including nearly 26,000 physicians across 8,600 practices and 600 medical billing companies nationwide.

    CedarBridge Group, a specialty consulting and software firm, which helps healthcare organizations make more through effective use of data through smarter technology deployments.

    Clinical Architecture, which develops software focused on the quality and usability of clinical data, helping providers with interoperability, decision support, analytics and more.

    CompuGroup Medical, which focuses on clinical and practice management activities in physician practices, community health centers, hospitals and labs.

    DataFile Technologies, which partners with EHR companies to help with clinical workflows and secure exchange of health information.

    Forward Advantage, which develops technologies for health information exchange, identity and access management and more.

    Prosocial Applications, whose mobile tools are aimed at consumers with chronic, complex and rare conditions across care settings.

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

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    CRISPR-Cas9, the so-called "molecular scalpel" that enables the editing or deletion of entire genes, promises exciting new avenues for treatment.

    It's arguably true, at least so far, that CRISPR's "hype eclipses early success stories," said Ross Wilson, principal investigator at UC Berkeley's California Institute for Quantitative Bioscience, at the HIMSS Precision Medicine Summit this past June.

    But early trials are already showing big promise on some of the most vexing genetic conditions, and we're only about five or 10 years away from seeing genome editing more routinely applied to "things that might be a bit more elective, but could have huge impact, since they're so common," such as Alzheimer's, diabetes and high cholesterol, he said.

    [Also: Genome editing tools set to bring monumental change to healthcare]

    In the meantime, a new development just touted in both Nature and Science, researchers from MIT and Harvard's Broad Institute, have discovered a new modification to CRISPR that can fix smaller pieces of an individual's genome – paving the way for even more precise precision medicine techniques.

    DNA comprises four nucleobases: A (adenine), C (cytosine), G (guanine) and T (thymine). As explained this week in the MIT Technology Review, they each pair off – A with T, C with G – to create DNA’s double helix shape.

    [Also: Regenerative medicine, gene editing markets are growing]

    The new approach, called base editing, uses a modified version of the CRISPR tool, allowing researchers to change those letters one at a time, without making breaks to DNA’s structure.

    "Standard genome-editing methods, including the use of CRISPR-Cas9, make double-stranded breaks in DNA, which is especially useful when the goal is to insert or delete DNA bases," said David Liu, a Harvard chemistry professor and member of the Broad Institute. "But when the goal is to simply fix a point mutation, base editing offers a more efficient and cleaner solution."

    Wilson likened the new technique to swapping out a word in a large paragraph of text, rather than editing out the paragraph itself.

    "It’s a lot of DNA to move around," said Wilson of the previous of CRISPR. "With base editing, you could just change the single word."

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    That rural hospitals are struggling isn’t exactly a secret. More than 80 rural facilities have closed since 2010, and recent research from iVantage Health Analytics found that 41 percent of them are operating at a negative margin. Some of these hospitals are surviving by partnering with larger regional health systems. Some are changing their care delivery models entirely.

    But others have found success simply by overhauling their electronic health records.

    The functionality of many EMR systems is patchwork in nature, making it cumbersome for small staffs to handle things like billing and meeting meaningful use requirements. Fewer workers tackle more complex tasks, which makes it a struggle to operate in the black.

    [Also: Struggling rural hospitals look for ways to access needed technology]

    Make the EMR system simplified and more automated, however, and now these rural hospitals have got a fighting chance.

    That’s been the experience at Rawlins County Health Center in Atwood, Kansas. Sharon Cox, Rawlins’ CEO,, and Destiny Schroeder, its information systems director, decided a more automated approach would help improve the hospital’s financial outlook, and so far, they’ve been right.

    “We were running a couple of different systems that weren’t integrated, and this was an opportunity to do that,” said Cox. “One of the things you have to do in a hospital that’s small and with very few resources is you have to use technology to leverage resources, because we don’t have the staff or the expertise.”

    [Also: CPSI, Caravan Health align to help rural providers form ACOs]

    There are different ways to streamline and automate an EHR system. Since wallets were light, Rawlins partnered with athenahealth to make the required overhaul. The turnaround was pretty dramatic, and put into stark contrast some of the deficiencies of Rawlin’s old legacy system.

    “A big part of that was meaningful use and being able to meet meaningful use requirements,” said Schroeder. “That changes year to year, it seems, are there are more requirements that need to be done for that. With the legacy system we had, not all of our meaningful use data could be collected within one system. We had several different systems we had to go through that was kind of piecemeal ... even to do day-to-day tasks. We’ve seen a huge difference with that. That’s made it a much easier process.”

    “Small and rural hospitals see this as a foundational element to success in the future,” said Cox. “So many of those hospitals were looking at such dire circumstances, and how they were going to survive in the future.”

    Workflow relief

    One of the big things this has accomplished has been to take administrative tasks off providers’ plates -- something that becomes especially important when staffing and resources are limited. 

    Rawlins has seen a huge change in its workflow -- take charge entry, for example. Before the switch, the staff had to wait until the day-end close to enter those charges, and so they wouldn’t be seen in the account until the next day. Now, for the people in medical records, they can see all of the changes and see where they have results. That makes for a quicker workflow process; they can close the visit and drop a claim, whereas before it might have been strung out over several days.

    Coteau des Prairies, a 25-bed acute care community hospital in South Dakota, has turned its financial picture around following a similar approach. For CEO Michael Coyle, the desire to streamline EHR stemmed in part from a lack of technical expertise on the part of the hospital’s small staff.

    “We don’t have gurus here -- we’re too rural,” said Coyle. “Whenever something went down, it seemed to take forever to fix. We’re a very busy hospital. The longer we’re down, the longer it takes to catch up. Burnout happens.”

    A streamlined, automated EHR has helped staff avoid that burnout, and has made operations at the hospital much more efficient. That’s been reflected in Coteau des Prairies’ bottom line, which has improved substantially. That’s no small feat: The hospital has a high Medicaid population and sits close to a Native American reservation, with 60 percent of the overall population comprised of Native Americans.

    “We meet with our client representatives every Friday and we go through what we need to be profitable,” said Coyle. “We’ve seen huge financial changes, probably upwards of seven figures. It will be close to a seven-figure turnaround by the end of the year. We’re doing front-end collections better than we ever have before. We’re not missing charges like we were in the past. And when the patient’s ready to go, the chart’s done, so you can print out a summary and take everything with you.”

    Coyle said automated EHR systems are a requirement for survival in the rural healthcare market these days, at least for those facilities who are resistant to partnering with a larger health system. Further necessitating this shift is a rapidly changing healthcare system marked by uncertainty in Washington in regards to reform and how care is delivered -- and paid for -- in the future.

    “Anytime you put the federal government into healthcare, it makes it more complicated,” said Coyle. “Just the little things, like the 340B program going away. That’s a huge revenue source for us. That’s how we pay for a lot of our charity care. And you’ve got to incentivize your providers. If they have to create a chart and they’re not creating (relative value units), they’re not making money. With all the changes that are coming, the technology we use needs to be functional, and it needs to respond to what the government is asking us to do.”

    The numbers don’t lie. Since implementing the approach, Coteau des Prairies has seen a 20 percent reduction in cost, and a 20 percent increase in revenue -- a 40 percent swing overall.

    Twitter: @JELagasse
    Email the writer: jeff.lagasse@himssmedia.com

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    Drchrono, a vendor of EHR, practice management, medical billing and revenue cycle management applications for the iPad, iPhone and the web, has unveiled the drchrono UrgentCare EHR. The new EHR system includes practice management and EHR features for urgent care practices.

    The features include: prebuilt charting forms for common urgent care conditions, macro text shortcuts that expand to speed urgent care charting, online scheduling, a virtual waiting room queue with patient wait times, iPad Kiosk waiting room self-check-in, mobile app patient self-check-in, urgent care patient profiles, urgent care billing profiles, real-time reputation management, a native mobile EHR app for iPad and iPhone, telemedicine, business intelligence reporting for clinic productivity, and patient engagement metrics.

    [Also: Providers lagging on 2015 Edition EHR certification, survey says]

    The company also has debuted custom appointment status, appointment dashboard and patient portal features designed to help urgent care practices gain insights into where patients are spending time and to streamline the patient journey.

    “Whether you have a well-established urgent care practice with multiple locations or one of the smaller primary/urgent care clinics, efficient patient care remains the critical goal to provide the best possible care to the largest possible number of patients in the least amount of time,” said Daniel Kivatinos, co-founder and COO of drchrono. “Despite the best intentions and skills of providers, there are a number of factors that can slow doctors and practices down.”

    [Also: Medsphere Systems, Stockell Healthcare merge in marriage of EHR, revenue cycle tech]

    Drchrono UrgentCare EHR offers urgent care clinics comprehensive capabilities to minimize suboptimal practice management conditions and enhance patient encounter, patient experience and clinic productivity, Kivatinos added.

    The drchrono UrgentCare EHR custom appointment status feature allows urgent care clinics to create a list of custom appointment statuses relevant to their workflow. They can also build custom appointment statuses to help indicate where the patient is in terms of appointment steps and exam room/office location.

    The appointment dashboard updates let the front desk staff know who has checked-in and/or who is a walk-in, which enables the staff to start adjusting the appropriate patient queue. Both the clinic staff and physicians will know how long a patient has been waiting in respect to their original appointment time and how long at each stage of the appointment.

    And the patient visit data reporting feature shows the traffic over the course of days and time (hours and minutes) so that urgent care clinics can gauge peak and valley of their visitor volume in a given day or week and prepare their staff schedule accordingly.

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

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    UMass Memorial Health Care CIO Tim Tarnowski says his system’s Oct. 1 Epic go-live could be a model for change management, calling it “the smoothest go-live that I’ve ever been a part of.” 

    Tarnowski, who has been doing this type of work for 30 years, has led two other Epic implementations in the past as well as rollouts of EHRs from multiple other vendors, he said.

    UMass Memorial, which serves central Massachusetts, operates four hospitals, with 1,600 physicians on the medical staff.

    [Also: UMass Memorial Health Care poised for Epic go-live on Oct. 1]

    While the go-live at UMass may have been smooth, it was not without its glitches. In fact, the CIO said there were thousands of them, it’s just that they were expected.

    Many of the issues ranged from not being able to log into the system to users who could not remember where to find something, Tarnowski said.

    [Also: Epic is coming to UMass Memorial]

    The system is hosted remotely by Epic. There were issues with backend infrastructure configurations within Epic’s data center, but they were solvable, he said.

    “We have not what we’d call significant issues,” Tarnowski said. “To have a number of issues at go live – that’s simply part of what happens with major transformations,” he said.

    Getting workforce buy-in

    Tarnowski credits the successful go-live to exceptionally engaged personnel across the board. Extensive preparations were also key.

    Of UMass’ 13,000 employees, about 1,200 are frontline team members who participated deeply in the process, starting with the selection of the EHR.

    “Our belief is we want to get the frontline heavily involved,” Tarnowski said. “As an organization, we made it a top priority. And when I say that, I mean everybody. Everybody who had to get to training went to training. Everybody who had to help design the system, participated and engaged.”

    Tarnowski described conference rooms overflowing because people were so highly engaged and interested in the project.

    “I have worked places where you schedule a meeting for 30 people, and 15 show up,” he said. “Here, we scheduled it for 40 and 60 showed up. The frontline engagement was fabulous on this one.”

    One of the keys to an optimal rollout, as he sees it, is that frontline engagement in the selection of the EHR -- and especially in the design, and it proved to be the case with this implementation, he said.

    He also credits UMass Memorial Health Care President and CEO Eric. W. Dickson, MD, and his team for helping to pushing the decision making as deep as possible in the organizing and for making his rounds to hear first-hand how things were going.

    Cost, of course, is always a factor. The $700 million price tag for the project pays for infrastructure, training, hardware, network closets, better bandwidth and a Microsoft Office suite. The EHR cost comes in at about $200 million, he said.

    Dickson has said that if the EHR, which replaces a patchwork of technology from several other vendors, increases hospital efficiency by just 2 percent each year over the next five years, it will have paid for itself.

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

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