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Articles on this Page
- 11/08/17--11:42: _ONC contest winners...
- 11/09/17--08:30: _VA email system twe...
- 11/10/17--10:54: _EHR vendors, AHIMA ...
- 11/10/17--11:28: _Unsealed VA EHR pla...
- 11/10/17--13:30: _AHIMA: Here's how h...
- 11/13/17--10:29: _Doctors spend too m...
- 12/04/17--10:00: _Protecting Medical ...
- 11/14/17--09:41: _AMA President: We'r...
- 11/14/17--10:23: _Meditech rolls out ...
- 11/14/17--11:50: _CliniComp tells VA ...
- 11/14/17--12:36: _UC Health goes live...
- 11/15/17--08:10: _Providers need thei...
- 11/15/17--09:02: _Blockchain beyond E...
- 11/15/17--11:30: _A CIO's journey to ...
- 12/05/17--10:00: _The Impact of Conne...
- 11/16/17--13:16: _Cerner DoD overhaul...
- 11/29/17--11:00: _Crawl, Walk, Run: T...
- 11/16/17--13:48: _CHIME drops Nationa...
- 11/17/17--07:56: _eClinicalWorks sued...
- 11/17/17--09:08: _More than half of E...
- 11/10/17--13:30: AHIMA: Here's how hospitals should document opioid abuse in the EHR
- 11/13/17--10:29: Doctors spend too much time on EHRs? Most patients don't think so
- How and why hackers are aiming to disrupt healthcare services
- Review real world scenarios and their significant impact to the healthcare organization
- Tools and processes healthcare organizations should focus on for the future
- 11/14/17--12:36: UC Health goes live on shared, cloud-based Epic EHR
- 11/15/17--08:10: Providers need their EHRs for MACRA, but too bad they hate them
- 11/15/17--11:30: A CIO's journey to EHR success and stability
- 12/05/17--10:00: The Impact of Connectivity on Rural Hospitals & the Promise it Holds
- 11/29/17--11:00: Crawl, Walk, Run: Three Real World Patient Matching Case Studies
- 11/16/17--13:48: CHIME drops National Patient ID Challenge
The Office of the National Coordinator for Health Information Technology has revealed the winners of its Patient Matching Algorithm Challenge, launched this past June. More than 40 competing teams, using an ONC-provided dataset, offered some 7,000 submissions that explored a variety of solutions to the matching problem.
They were judged across a series of categories. The big prizes, for best "F-score," which measures accuracy factoring in both precision and recall, went to Palo Alto, California-based Vynca ($25,000 for first place), Cambridge, Massachusetts-based PIC-SURE ($20,000 for second place) and Ann Arbor, Michigan-based Information Softworks ($15,000 for third place).
[Also: Patient matching strategy gains ground with support from Congress]
Information Softworks also won $5,000 for best first run, while PIC-SURE was awarded $5,000 each for best recall and best precision.
Vynca's winning stacked model combined the predictions of eight different other models, and relied on manual review for fewer than .01 percent of the records, according to ONC.
PIC-SURE's algorithm was based on the Fellegi-Sunter method for probabilistic record matching and was accompanied by a substantial manual review. Information Softworks also used a Fellegi-Sunter-based enterprise master patient index system and required limited manual review.
The ONC dataset and scoring platform from the challenge is still available for researchers who'd like to do further algorithm development; it can be accessed via the Patient Matching Algorithm Challenge website.
"From an interoperability perspective, the ability to complete patient matching efficiently, accurately, and at scale has long been identified as a key element of the nation’s health IT infrastructure," said Steve Posnack, director of ONC's Office of Standards and Technology, when the contest was first announced. "Patient matching is almost universally needed to enable the interoperability of health data for all kinds of purposes."
But despite "numerous recommendations have been issued over the years to tackle different aspects of patient matching," he said the challenge of consistently matching patient data as they move among care settings is still a vexing one for healthcare – posing challenges for efficiency and risks to patient safety.
“Many experts across the healthcare system have long identified the ability to match patients efficiently, accurately, and to scale as a critical interoperability need for the nation’s growing health IT infrastructure," said National Coordinator for Health IT Don Rucker, MD. "This challenge was an important step towards better understanding the current landscape."
The U.S. Department of Veterans Affairs announced this week that it has retooled its Inbox Notifications system, a messaging platform used to relay clinical information – test results, referrals, medication refills – to its clinicians.
Like many an email inbox, over the years the system has become rife with non-urgent or unimportant messages, according to the VA.
So a team led by Tina Shah, MD, has worked to rearrange the messaging platform, working to weed out lower-value emails, officials said, and also training clinicians in ways to optimally manage their inboxes.
Shah, a 2016-2017 White House Fellow, has experience with a redesign. A pulmonary and critical care physician, she did a clinical fellowship at the University of Chicago, where she redesigned the care cycle for patients with Chronic Obstructive Pulmonary Disease, leading to a big reduction of hospital readmissions.
The new Inbox Notifications system seems to be working well so far. The VA says its clinicians are now spending an hour-and-a-half less on emails each week, on average, freeing up their schedule to enable more face time with their patients for quality care.
"The public never sees the excessive amount of emails and alerts that take up a doctor’s time," said VA Secretary David J. Shulkin, MD, in a statement.
"Some of it is necessary, but other emails do nothing to advance patient care and can, in fact, pose a major safety hazard because of lesser important emails," he added. "We want our doctors to have the right information they need to provide quality healthcare to veterans, and this is a step in the right direction."
Some studies have estimated that physicians can spend two hours on administrative work for every hour spent with patients.
"When we let doctors do what they do best – giving care to veterans – we know it improves the care they receive," said Shulkin. "This initiative is just one of many underway for VA to address clinician burnout and improve the quality of our care."
Electronic health records software can play a more prominent role in helping to prevent patient falls, AHIMA said in new research.
EHR vendors such as Epic, Cerner and Meditech, in fact, have been working to equip doctors with tools and data to make that happen since 2015.
But AHIMA found that “physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time,” in its study, “An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls.”
The question now is how hospitals can get that screening percentage higher both for patients’ sake and because there are billion of dollars at stake?
A public health problem
Falls are mostly preventable. There are several things that primary care providers can do to reduce their aging patients’ chances of falling. The Centers for Disease Control and Prevention, for instance, developed the STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit.
Based on the American and British Geriatric Societies’ Clinical Practice Guidelines, STEADI includes algorithms and tools to help primary care providers identify and manage fall risk among older adult patients.
The CDC estimates that for every 5,000 providers who adopt STEADI, over a five-year period as many as 6 million more patients could be screened for fall risk, 1 million more falls could be prevented, and $3.5 billion saved in direct medical costs.
Working with Oregon Health & Science University, the University of Wisconsin and the CDC, Epic developed system tools that a healthcare organization can use to implement and support STEADI. The tools screen for fall risk; assess gait, strength, and balance; conduct a full fall risk evaluation; identify patient goals; intervene; and monitor outcomes.
Epic calls this a “clinical program,” which pulls together decision support tools and other aspects of Epic’s EHR into a targeted improvement workflow based on the success of others. Epic also has a general inpatient falls prevention program developed by the Epic Nursing Collaborative. This program uses EHR system and non-system strategies to reduce falls, strategies that can be tailored to fit an organization’s needs.
The nursing-generated program incorporates best practices from each organization represented in the collaborative, including Aurora Health Care, Cedars-Sinai, Children’s Hospital of Colorado, Cleveland Clinic, Kaiser Permanente, Stanford, Texas Health Resources, University of Arkansas, University of Colorado Health, University of Iowa and the University of Virginia.
Epic is not the only EHR vendor to adopt STEADI. Other marketshare leaders including Cerner, Meditech and Allscripts have done so as well.
What the CDC, universities and EHR vendors are doing with STEADI is, of course, not a magic solution to fall prevention.
AHIMA researchers called for implementing clinical decision support tools more deeply into EHRs as a start. That would better enable care teams to pinpoint and intervene before at-risk patients fall.
Take El Camino Hospital in California. The 420-bed system integrated analytics and bed alerts with its EHR. The combination predicted which patients were at risk for an imminent fall and alerted nurses and case managers in real time, which was one factor that helped result in a 39 percent reduction in falls within six months of starting the program, chief nursing officer Cheryl Reinking said at the HIMSS and Healthcare IT News Big Data & Healthcare Analytics Forum in April 2017.
“Electronic health record data can be applied in clinical decision support,” AHIMA interim CEO Pamela Lane said of the association’s new report. “By leveraging the data in a way that is sensitive to the time constraints of the regular office visit and the reduction of healthcare costs, identifying patients at risk of falls can be streamlined.”
After months of waiting to hear details on the U.S. Department of Veterans Affairs’ plans to replace its EHR with Cerner, recently unsealed documents reveal the agency is hoping to create a single, common system between the VA and the Department of Defense.
To accomplish this, VA Secretary David Shulkin, MD plans to replicate DoD’s Cerner EHR, which has successfully rolled out at four DoD sites.
The unsealed documents were written by U.S. Court of Federal Claims Judge Lydia Kay Griggsby, who just last month ruled to dismiss a lawsuit filed by CliniComp against the government for the VA’s no-bid contract with Cerner.
Her opinion shed light on Shulkin’s plans for the massive project. In fact, it’s the most detail shared with the public on how the VA intends to build its EHR.
According to the Determinations and Findings filed with the court by Shulkin, Cerner will install its EHR at 1,600 VA healthcare sites in the U.S. The contract will be implemented in 48 phases, including site visits, user training and onsite support, over the next 10 years.
But the cost of the EHR was redacted.
“It is in the public interest to directly solicit a sole source contract to Cerner to achieve a single common EHR system with the DoD,” Shulkin wrote.
To Shulkin, a “single common system” would be implemented in a way that would allow the VA to adopt the same workflows, cybersecurity architecture, order sets and terminology as the DoD. In doing so, the VA’s EHR would work seamlessly with the DoD’s regardless of the agency where the patient receives care.
“Veteran’s complete and accurate health record in a single common system is critical to providing seamless, high-quality, [and] integrated care and benefits,” Shulkin wrote. “Records residing in a single common system will eliminate the reliance on complex clinical interfaces or manual data entry between DoD and VA.”
Further, by using a common system, the VA hopes to avoid repeating mistakes and capitalize on DoD’s lessons learned, while ensuring the VA won’t need to develop or maintain an increasingly complex EHR.
Shulkin is also hoping the platform will make it easier to analyze the agency’s unique data sets to determine trends among service members and veterans. The system will also make it possible for the VA to make faster disability determinations -- an issue that has long plagued the agency.
Also noted was Cerner’s reputation for working closely with its clients to ensure the platform’s success.
“As the prime contractor and EHR software developer, Cerner is best positioned to not only lead software implementation, but also to conduct a robust review of VA clinical processes for quality improvement and business transformation,” Shulkin wrote.
The VA made the decision to replace its legacy VistA EHR in June, after two RFIs and a private audit. Shulkin said the VA went with Cerner to match the EHR already in place at the DoD.
Cerner will be in charge of the EHR and supporting functions like revenue cycle, inpatient and home care -- among others. The contract will also address non-clinical core functional requirements, which may include inventory management/supply chain capabilities.
As the U.S. takes aim at the opioid crisis, the American Health Information Management Association has put together a tip sheet to help clinicians better document how their patients are using these dangerous drugs.
Patients' use or abuse opioids is documented in their electronic health records, but how easily that data can be used by other providers across the care continuum could play a big role in how those patients are treated.
"There are seven characteristics of high-quality clinical documentation. If a provider learns how to document using these characteristics to guide their documentation habits, they will provide trustworthy documentation," the group said.
Those characteristics that best define optimal EHR charting are: clear, consistent, complete, reliable, precise, legible and timely.
We've already seen an array of technology-focused interventions, from better cybersecurity protections for e-prescribing of controlled substances to smart caps and automated pill dispensers to help prevent the doctor shopping and overuse that fuel the opioid epidemic. But clinical documentation improvement and interoperability have crucial roles to play.
AHIMA's Opioid Addiction Documentation Tip Sheet lays out those characteristics alongside hypothetical examples of what clinical documentation for potential opioid abusers would look like if they were – or weren't – followed.
With unclear charting, for instance, symptoms are documented without a clarification of a supporting diagnosis. Inconsistent documentation can sometimes be conflicting. When it's incomplete, abnormal findings are noted without an associated condition.
Unreliable EHR data might show a given treatment provided without a documented condition. Imprecise records are unclear on a given diagnosis. Illegible notes can be difficult to decipher. Untimely documentation is asynchronous with the time care is being delivered.
For example of the importance of clarity, AHIMA points out that a doctor might write, "27-year-old male admitted with lethargy. History of drug use."
But why was the patient lethargic? A more useful and potentially life-saving way to make the note would be "27-year-old male admitted with lethargy due to opioid dependency and overdose."
With regard to completeness, AHIMA offers another example of a note that could be better: "42-year-old female admitted for somnolence and abnormal drug screening." Again, why? What is the diagnosis that supports that? A better note would read "42-year-old female admitted with drug dependence and intoxication of Oxycodone as evidenced by positive drug screen for opioids."
Any one of those less-than-ideal characteristics – let alone several at once – can lear to a patient record that doesn't tell the whole story, or doesn't tell it accurately. As the suboptimal notes increase, so do the chances that signs of opioid dependency could be missed, especially as the patient moves from provider to provider.
Given all the hue and cry about electronic health records distracting clinicians and inhibiting their ability to make eye contact with patients during office visits, the consensus has been that doctors waste precious time on EHRs. But new research suggests fewer patients feel that way than one might expect.
But that doesn’t necessarily mean they believe EHRs make care safer.
Sixty percent of respondents answered “no” when asked if clinicians spend too much time on a computer during the typical appointment, according to HealtheLink, a health information exchange in Buffalo, NY.
HealtheLink conducted the survey among 1,000 patients, and hospital and IT executives around the country can learn from the results about perceptions of EHRs and patients portals.
The 60 percent of respondents who do not think their doctors spend too much time working in the EHR is surprising, for instance, but there was still 37 percent who said physicians spend too much time — that rose to 47 percent among respondents who see a doctor five or more times a year.
Then there is the question of whether EHRs improve patient safety: 51 percent indicated that they believe using EHRs makes healthcare safer but the rest is divided into 18 percent who said EHRs actually make healthcare less safe and 24 percent answered that the software has no impact either way.
Whereas 90 percent of patients are aware that their clinicians use electronic health records and 72 percent know their primary care doctor has a patient portal, 41 percent have used the portal.
Finally, to the broad question of whether electronic access is good for healthcare 82 percent answered in the affirmative with 58 percent saying “yes” and 24 percent giving a “strongly yes” answer. And HealtheLink said that particular statistic spans all the demographic and age groups it surveyed.
As WannaCry and NotPetya have demonstrated, connected medical devices in operation today were not designed with security in mind. In fact, many were not initially designed to be networked and certainly not exposed to the Internet. EMR and other initiatives have accelerated the need to network medical devices at the risk of security exposure. With traditional IT security solutions unable to secure connected medical devices, there are no easy answers to address the risk to the millions of devices currently in operation.
Dr. Maia Hightower, CMIO of Iowa University Health Care and Dr. May Wang, CTO of ZingBox will review the approach many organizations are taking to safeguard their network of connected medical devices and advancements that can be expected in the future.
Join this presentation to learn:
The American Medical Association is fighting to prevent information blocking or to stop vendors from making it expensive for physicians to share data, AMA President David Barbe, MD, said over the weekend at AMA’s interim meeting.
Further, AMA is working to improve the usability of EHRs, mobile devices and interoperability.
“And we are making progress,” said Barbe. “We’re fighting physician burnout. Our work to improve patient satisfaction by reducing these headaches and making the practice environment more satisfying is at the heart of the AMA’s shared strategic vision.”
Barbe hailed the group’s regulatory victories, which include work to help physicians avoid penalties under Medicare’s payment program, if the provider reports one quality measure on one patient for one year.
“We’re working to make sure every physician -- in every practice setting and every specialty -- is prepared to make the successful transition to the MACRA-QPP,” said Barbe. “We’ve posted multiple resources on our website including tools, tutorials, podcasts and education modules.”
He also highlighted the group’s efforts on improving provider satisfaction.
The weekend’s meeting “recapped an aggressive year of advocacy and accomplishment, highlighting significant victories that protect patients and physicians, with the primary goal of improving the health of the nation,” Barbe wrote on the company’s blog.
Barbe also highlighted AMA’s dedication to “protect insurance coverage gains on behalf of millions of Americans.” He specifically pointed to AMA’s successful work to prevent the massive mergers of Aetna and Humana, along with Anthem and Cigna.
“Our success will be determined by how well we play or work together, as a team, to achieve our common goals,” said Barbe. “Sometimes, for winning teams, it’s all about the defense.”
“While it’s impossible to predict where the debate will go from here, our steadfast commitment to putting patients first and our unwillingness to be drawn into the partisan quagmire will continue to reassure the public that the AMA -- as the house of medicine -- is a voice of reason in Washington,” he added.
Meditech has launched a new offering for its critical access hospital customers: Meditech-as-a-Service, a cloud-based EHR that's available through a monthly subscription.
MaaS aims to offer smaller hospitals a way to improve process efficiency and drive quality improvement, giving them a cost-effective, modern EHR system with simplified contracting, officials said.
With MaaS, Meditech is joining other cloud-based electronic health records vendors, such as athenahealth and eClinicalWorks, with subscription options geared for smaller hospitals. Epic revealed earlier this year its plans to develop new versions for the same market segment as well but has yet to state the timeframe for those products becoming available.
Meditech, which said it will run MaaS out of a centrally-hosted private cloud infrastructure, will maintain responsibility for upgrades and ongoing maintenance of the system.
The suite of tools includes Meditech's Web EHR, equipped with clinical decision support, revenue cycle, patient access capabilities and more. The company said critical access hospitals should be able to roll out and go-live with the cloud-based systems in about six months.
"Reducing the complexity and cost of procuring and maintaining an EHR will allow these hospitals to focus their resources on patient care, productivity, and meeting regulations," said Meditech President and CEO Howard Messing in a statement.
California-based EHR developer CliniComp has offered to settle its lawsuit against the government if the U.S. Department of Veterans Affairs will agree to have a technology professional assess the company’s platform to determine if the tech is cheaper, faster and better than Cerner.
“CliniComp is only asking for an opportunity to prove that its commercial product can save billions of dollars of taxpayers’ money and can achieve what the VA is seeking but in significantly less time,” according to the settlement offer.
“In essence, let’s have this matter resolved by skilled information technology professionals who work for the government,” it continued. “The government has never allowed CliniComp to demonstrate that its commercial product has such capability.”
As the company is currently involved with EHR contracts for 56 Department of Defense facilities and 44 VA facilities, the company asserts that it has insight into what is required to obtain seamless interoperability between the government agencies.
In fact, CliniComp is so confident in the capability of its product, it’s offering a no-cost contract to the VA that “will provide CliniComp with a bona fide opportunity to demonstrate to the VA, using its own funds that its advanced technology can achieve a high level of interoperability between the VA and DoD EHRs.”
If the VA agrees, the agency can engage the GSA’s Federal Systems Integration and Management Center to run a benchmark test to determine if CliniComp’s existing EHR software “meets or exceeds the level of interoperability as baselined in the DoD and VA Joint Interoperability Certifications to Congress.”
CliniComp filed suit against the government in August for awarding Cerner the VA EHR contract without a standard competition process, which the company said lacked reasonable basis and called the decision to pick Cerner “arbitrary.”
A judge dismissed the case in October, based on jurisdiction. But recently unsealed documents written by U.S. Court of Federal Claims Judge Lydia Kay Griggsby, who dismissed the case, found that CliniComp wouldn’t have been a competitor for the VA contract, as the company doesn’t have experience performing a government contract of a comparable value.
VA Secretary Shulkin said the agency plans to replicate the DoD’s Cerner EHR to create a common system that will be implemented over the next decade in 48 phases.
While the matter seemed settled with the case dismissal, CliniComp said it’s determined to continue to fight for an opportunity to demonstrate its product is capable of handling the VA’s EHR replacement.
The University of California San Diego Health and UC Irvine Health have rolled-out a single EHR platform from Epic, in a collaboration designed to decrease patient care costs and improve operational efficiencies, the providers announced today.
Both health groups are now sharing a single cloud-based repository of patient medical records from Epic. Touted as the first of its kind, the collaboration within UC Health is the first time Epic has been extended from one U.S. academic medical center to another.
UC San Diego Health first implemented its Epic platform in August 2005, while UC Irvine implemented the same platform beginning this month. UC San Diego also shares its Epic platform with UC Riverside Health clinics and community partners.
The shared platform integrates the medical records from both sites, allowing the organizations to care for patients in Imperial, San Diego, Riverside and Orange counties.
The collaboration is part of a larger movement to “systemness,” which combines assets and services of organizations to improve patient care.
The providers estimate the cost avoidance for implementation will be about 30 percent. Implementation of the shared platform took about 17 months, which is shorter than the average 24-month implementation of similar roll-outs at academic health systems.
Further, the shared platform transitioned the Epic EHR into a cloud-hosted environment, which will help the providers meet industry standards for safeguarding patient health information.
The collaboration “aligns with the broader strategic goals of UC Health to share services and generate efficiencies across campuses through shared implementation and maintenance of technology platforms,” Christopher Longhurst, MD, chief information officer, UC San Diego Health said in a statement.
“Through this process, we’ve aligned our clinical pathways and practices to leverage the best of both organizations,” he added.
Despite high participation rate for MACRA's Quality Payment Program, providers may not be set up for success. New findings from analytics company SA Ignite and Porter Research shows the electronic health records systems they are relying on to help them report data are largely seen as inadequate and unsatisfactory.
The State of QPP Preparedness Industry Report, which analyzed feedback from nearly 120 health system executives regarding their organizations' preparedness for the QPP, found that while most health systems are relying solely on their EHR or population health management solutions to execute their quality reporting, most respondents said they're dissatisfied with the performance of those systems. That contradiction could meal they fall short of payment incentive goals.
Ninety-four percent of the study respondents are actively participating in the QPP, showing the forward momentum of value-based program adoption, SA Ignite said, and 97 percent said their organizations are relying on their EHRs or PHMs for reporting. But low confidence in those systems prevails, particularly pertaining to crucial functions for QPP performance like identifying all eligible clinicians, pinpointing focus areas to increase scores and seeing overall MIPS score/estimated financial impact.
Another paradox lies in the 64 percent of respondents who said they want to maximize their QPP payment incentives. Despite that sentiment, 73 percent of respondents said their system vendor doesn't offer a specific QPP management solution, meaning they don't have a program that is specifically geared toward participation in the QPP, navigating its requirements and producing the desired data, the report showed.
There is also widespread variation among respondents as to who actually oversees their QPP effort. Management departments cited included quality, clinical, administrative, IT, and population health departments as various managers of the program, the report said.
"EHR and PHM solutions were designed to manage patient care, not to optimize performance in value-based programs," said Matt Fusan, director of customer experience of SA Ignite, whose products include analytics support for MACRA. "It should come as no surprise that these solutions don't have the necessary functionality to support quality performance management. Healthcare leaders hoping to maximize their incentives must look beyond the EHR to solutions that mitigate complexity and facilitate proactive program management."
The report offered guidance on how to deal with this challenge and streamline processes since MACRA reporting is already underway. First, be mindful of who you actually need to measure. Clinician rosters can change and there could be reporting options or requirements you aren't aware of.
"Having the ability to scope out scenarios, or compare results at an individual and group level, is one-way healthcare organizations can optimize performance," the report said.
Second, know what to measure and how to report your data. With multiple measures in the QPP categories, each with a different weight, set of benchmarks and exclusions it is crucial to know what measures will have the greatest impact. Identifying hidden opportunities, forecasting scores, confronting shortcomings and choosing the best reporting method are all essential to success.
Third, get organized and get into the right mindset. Making the move to value-based care requires significant cultural changes within your practice as well as organizational changes. These should be in place before you jump into reporting.
Fourth, know what your organization is capable of handling, especially when it comes to how much you report. "With value-based care programs set to expand over the next several years, providers must determine what is possible and practical for their specific organization. It is important to set realistic goals based on realistic plans," SA Ignite said.
Finally, make a multiyear plan. The QPP and incentive-based payment models are going anywhere, though they will certainly evolve over time. Having a long-term plan on how your system or practice will continue to participate and adapt to the new regulatory requirements is key to not only getting by but thriving under the new frameworks.
The considerable hype around blockchain is starting to be tempered by enterprises earning practical experience and identifying worthwhile use cases for the technology.
Most of the buzz around blockchain in healthcare has focused on EHRs, interoperability and security, but a new potential for value-based care, precision medicine and a patient-driven healthcare system are emerging as more clear and present opportunities for the distributed digital ledger technology.
While we don’t expect the hope for data interoperability and security to fade away, hospital executives who want to stay abreast of what’s really happening with blockchain will also need to understand these new considerations.
Blockchain and the move to value-based care
A variety of possible use-cases for blockchain are coming into focus for healthcare, ranging from clinical to financial to administrative.
“Traditional healthcare fee-for-service payment systems are overly complex and expensive from an administrative perspective. On average, payment administration accounts for about 14 percent of healthcare spending. Blockchain applications can definitely reduce the waste,” said Corey Todaro, chief product officer at Hashed Health, which leads a consortium of healthcare companies focused on accelerating innovation using blockchain.
Beyond fee-for-service, blockchain as a technical architecture can enable value-based payments to take off and thrive, some experts said.
“Blockchain can enable a smart payment system to match the distributed care teams that will take responsibility for episode- and disease-centered payment models,” Todaro added.
Claims adjudication and billing management is ripe for a blockchain-based system that can provide realistic solutions for minimizing medical billing-related fraud; this is a highly relevant use-case given the amount of fraudulent activities around improper medical billing and reimbursements across the payer industry, said Tapan Mehta, market development executive in the healthcare practice at DMI, a mobile technology and services company.
“For example, in a situation where a health plan and patient are dealing with a contract, the blockchain could automatically verify and authorize information, as well as the contractual processes, eliminating the back-and-forth between multiple parties,” Mehta said. “This would increase transparency and efficiency, leading to lower administration costs, faster claims processing and less money lost.”
Precision medicine and a patient-driven healthcare system
Blockchain-based systems could help drive unprecedented collaboration between participants and researchers around innovation within medical research, particularly in the fields of precision or personalized medicine.
Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, said that blockchain can enable the patient-driven healthcare system.
“The lack of interoperability among data systems in a personal health network is a detriment on patient care,” she said. “Informed patients know that data is critical to enhancing their care and safety. This is beyond safety from data hacks, this is the ability for their healthcare providers to have access to information that will help them better treat the patient.”
There has been a trend in educating patients to manage their health to embrace wellness and prevention, and that may also include the data that is generated out of this practice, she added.
The best type of patient is an informed patient. If blockchain can deliver a patient-managed EHR system, the business of healthcare will be about delivering service and treatment to better health and not owning the patient’s health, Palombini said.
Precision medicine in clinical trials presents another big opportunity for blockchain innovation, Mehta said.
“According to IgeaHub, it is estimated that about 40 percent of clinical trials go unreported,” he said. “In fact, a majority of pharmaceutical research related to clinical trials is completed in silos, thereby making collaboration across an organization’s internal team impossible. This creates crucial safety issues for patients and knowledge gaps for healthcare stakeholders and policymakers.”
The contribution of wearables
Wearables and internet of things devices can also be integrated into the health IT ecosystem via blockchain.
“Health wearables are currently hoarding critical information for clinical research, outcomes of treatments, and disease prevention and management,” Palombini said. “However, in its current state, the information often sits in a repository where raw data may be inaccessible and never has the ability to be shared for other uses.”
If validated, this health data could be secured, shared and verified on a blockchain and the function of the health wearable takes on a whole new role, with, for example, clinical trial patient recruitment, clinical research and treatment of disease.
Indeed, patient-mediated health data exchange holds a big opportunity for blockchain innovation in healthcare. Blockchain can empower patients and data owners to control access to their healthcare data by using the blockchain as a system of record for patient consent and health data transfer activity.
“Today, patients have little access to their health data and cannot easily share with researchers or providers,” said Shahram Ebadollahi, chief science officer at IBM Watson Health. “Giving patients the opportunity to share their data securely, for research purposes or across their healthcare providers, creates opportunities for major advancements in healthcare. Blockchain technology is designed to make this a reality.”
As more and more patients gain that kind of control over their own data it will flow more efficiently across the system to create something a lot closer to a longitudinal view than what exists now and that, in turn, can enable more accurate data, better access to new treatment options and ultimately improved outcomes, Ebadollahi said.
Yes, this is where electronic health records come back into the blockchain picture.
Blockchain and EHRs
One big question is how might blockchain affect the evolution of the electronic health record? Blockchain can enhance EHRs in many ways, presuming healthcare CIOs and other executives want to move in that direction.
“Blockchain will help connect electronic health records across providers, to enable the full view of a patient’s health data, if patients provide the consent to do so,” Ebadollahi said. “This would be through a patient-mediated health data exchange.”
Currently, EHRs focus on clinical data. The fastest growing type of information is exogenous data, from mobile devices and medical devices and including genomics, Ebadollahi added, and blockchain can help connect these disparate sources to the more traditional clinical data.
The electronic health record, in fact, is generated from many different sources – hospitals, doctors offices, labs and more – each acting as the owner of the data. The fragmented network tying things together can be viewed as more about maintaining the business of patient care.
“If we look at the truly disruptive and emerging trend in blockchain and healthcare, the EHR will be created, maintained and distributed by the patient,” said IEEE’s Palombini. “Therefore, no longer multiple health records owned and operated by Healthcare Inc. Instead, it will be one record with multiple compartments containing data that was extracted as a service by one of these entities and given back to the person to add to their health record.”
These entities will no longer own a patient’s health record; they will merely contribute to the data in it as a rendered service, she added. Blockchain could flip the ownership and maintenance of the EHR completely upside down. It could empower patients to choose with whom, how much, and when they want to share their information, and not be beholden to any health system, she said.
Dave Watson Chief Operating Officer of SSI Group said that EHRs and blockchain working together have a long way to go.
“First, EHR vendors have so many pressing enhancements to deliver, and second, without clear and compelling use-cases, why would EHR vendors move blockchain up in the development queue?” Watson pressed. “They may entertain some proofs of concept or simply make positioning statements so they don’t appear to not be on the bandwagon, but that’s not a viable deployment of the technology.”
Blockchain and security
Another area in healthcare where blockchain could have a profound impact, like with EHRs, is cybersecurity. Blockchain can fundamentally change the way healthcare CISOs and infosec teams think about securing data.
“Blockchain offers a new combat strategy because it is not simply a security system, it is a technology that compels every enterprise professional to rethink their business operations in a digital universe,” Palombini said. “Blockchain is not a patch. It’s a whole new approach to distributing, managing and verifying information in a tamper-proof, decentralized system.”
All transactions are time-stamped and replicated in every block visible to permissioned users but can never be altered, only appended. The decentralized nature of the blockchain provides the ability to distribute anonymized, encrypted data that can be verified by credentialed users.
“This can provide traceability for all health data access, with transparency to auditors,” said IBM’s Ebadollahi. “Blockchain can provide integrity of data by maintaining indelible hashes of the data, so that any alterations of the data are detected.”
The distributed digital ledger technology can also can maintain keys for access to data, adding another level of security by working in concert with other systems to produce immutable audit logs, thereby making illegitimate access more difficult, Hashed Health’s Todaro said.
The largest opportunity is rethinking the movement of data in the healthcare ecosystem. Todaro explained that blockchain enables the development of light-data transactional models in which partners can get expanded utility without having to do large-scale data transfers or availability, both of which are sources of cybersecurity risk.
"One might argue that it may not be blockchain the technology that is oversold, but the amount of work to fix existing taxonomies, protocols and policies to fully maximize blockchain may be undersold."
Maria Palombini, IEEE Standards Association
Hype outpacing reality?
In the end, one might wonder whether blockchain is all it’s cracked up to be. Evangelists sure make blockchain sound like a panacea for all of healthcare’s woes. But is it? Or is there more hype than promise?
Today, the challenge in truly driving innovation in the healthcare system is the inability to obtain and share clean patient health data while maintaining data privacy. The current crop of data management systems are not designed to evenly negotiate the ability to share data while retaining privacy, so the default has been to safe-harbor the data and let data-sharing fall to the wayside.
“The lack of data-sharing has become a true impediment to advancing innovation in drug development and healthcare,” Palombini said. “The true value healthcare providers offer is not the service or product but the data they provide. The data is the key to innovation in finding treatments, disease prevention and more.”
The very nature of blockchain – to distribute information with anonymity in an encrypted and tamper-proof environment – provides the platform to overcome this critical barrier of data-sharing and privacy, Palombini said.
As history has shown time and again, however, technology for technology’s sake cannot fix all problems.
“One might argue that it may not be blockchain the technology that is oversold, but the amount of work to fix existing taxonomies, protocols and policies to fully maximize blockchain may be undersold,” Palombini said.
"It’s important to remember we are just at the beginning of blockchain’s potential in health, so it will take some time before its benefits are fully realized."
Shahram Ebadollahi, IBM Watson Health
An evolutionary journey
Palombini said that there are already more than 100 blockchains in existence across multiple vertical industry sectors.
“It’s important to remember we are just at the beginning of blockchain’s potential in health, so it will take some time before its benefits are fully realized,” IBM’s Ebadollahi said. “But it’s potential should not be underestimated.”
In the next five to 10 years, patient consent and data exchange backed by blockchain could fundamentally change the way healthcare services are provided by making patient longitudinal data readily available and opening the door to new treatments, new care delivery models and better coordination of care, IBM’s Ebadollahi explained. He pointed to blockchain underlying precision medicine and wellness programs outside the health systems as potentially having a large impact on outcomes.
And the matters of blockchain’s inherent limitations with respect to scalability, confidentiality and governance still need to be ironed out, SSI Group’s Watson said.
Working through those thorny issues will be an evolutionary journey for blockchain-based healthcare applications. Trust and governance are key as the interval between proof-of-concept production-quality technologies gets shorter. And building blockchain networks will require a lot of heavy lifting by software vendors and hospitals alike.
The numerous years spent planning, budgeting, organizing, pleading and addressing the daily unknowns are now behind many healthcare organizations as they look at life after their electronic medical record (EMR) implementation.
For many who are beyond this milestone, it is a relief to move into the world of optimization and seek new ways to enable patient care. But such a transition can be a bit perilous for unprepared hospitals. The new environment surrounding the post EMR transition is quite different than that of the implementation days.
Here are a few things to keep in mind:
You’re going to need a new management model. The EMR implementation world is filled with structure, process and defined deadlines. We all follow the marching orders of the almighty project work plan and develop sub-work plans to the master project work plan in order to keep our teams focused and on-track. Post EMR implementation is far less structured and requires a management model that keeps the team focused and productive.
It’s much harder to say NO in the post-EMR implementation environment. Many organizations commit to a fixed deliverable associated with their EMR install. Requests that fall outside of this fixed scope are often tabled for post activation. Of course this approach is well supported by senior leadership as they want the system to activate in as rapid a manner possible with as minimal expense and disruption as possible. Post EMR activation, the floodgates to the backlog of tabled requests opens. Everyone wants a piece of the optimization team; gently and not-so gently reminding the team of their partnership by delaying their request with the promise it would be addressed post-activation.
Hospitals transitioning to a new EMR are switching vendor platforms and as a result the data that is captured, distributed and reported upon is different than the prior paper-based or electronic system. It’s not that the new system data is wrong, but it’s definition, calculation or other characteristics are simply different. Tied to this phenomenon is the revelation that in multi-entity organizations, each entity often calculates seemingly standard metrics (ie: admissions, census. readmissions….) in different ways. Thus, no matter how the system reports the data, it is found to be inconsistent throughout the organization.
With the thrill of the EMR activation fading rapidly afterward, what’s a CIO and project leader to do? Gaining awareness of these common occurrences is a good start and having the understanding that with a little preparation, these items can be readily addressed goes a really long way.
A few suggestions to consider on your journey to EMR success and stability:
Your EMR implementation team will most likely be weary after the EMR activation. Long days spent working to meet project deadlines and even longer days supporting the EMR activation can take a toll on your team. Be sure to give these folks a break and have a new set of resources in place to provide the post activation and optimization efforts. Also, have some connection between the implementation and optimization teams to ensure that everyone understands the rhyme and reason for proposed changes.
The number one key to post-activation survival: Governance, governance and governance. Operational leadership must assist in providing guidance regarding the priority and scope of post-activation activities. People closest to the user community front line are often best suited to lead this effort, are invaluable in maximizing the efforts, and most readily recognize the benefits associated with the system.
Mobilize and strengthen your Data Governance committee in preparation for EMR activation. Identify the key metrics that your organization utilizes to manage the business and insure these data elements are consistently defined across the organization and properly calculated within the new system.
Since my organization’s final EMR activation in March 2017, I’ve shared the metaphor with many folks that implementing the EMR is like participating in the Tour de France because you spend an enormous amount of time and energy peddling uphill. And then riders reach a point where the painful and agonizing peddling (the implementation) transitions to the downhill, extremely fast and quite treacherous portion of the race (post implementation).
Both experiences are very different yet filled with equal levels of activity and exhilaration. I suspect that many people who have reached the peak and begun the dissent are enjoying the feeling of being on the other side with the ability to bring great benefit to their organization.
Through the efforts of those on my team and in operational support, I am one of those experiencing that thrill.
Now we begin a new leg of the journey.
Mike Restuccia is CIO of Penn Medicine.
Network reliability and availability of fiber-based services are acknowledged as key contributors to success at rural healthcare organizations adopting new care delivery models, but these same organizations also acknowledge challenges with funding and clinician buy-in in their efforts to enhance healthcare delivery. During this webinar, Bryan Fiekers, senior director of Research Services for HIMSS Analytics, will share the results of a new research study that explores the impact of connectivity on rural hospitals. In addition, Fiekers will offer actionable insights and prescriptive guidance into how rural healthcare organizations can gain the connectivity needed to help advance key clinical initiatives.
Now that Cerner has successfully rolled out its electronic health record platform at four military provider sites in the Pacific Northwest – Fairchild Air Force Base, Naval Health Clinic Oak Harbor, Naval Hospital Bremerton and, most recently, Madigan Army Medical Center in Tacoma, Washington – the "Initial Operational Capability" of the Department of Defense's massive MHS Genesis project is complete.
Now the real work begins – with the added challenge of also outfitting the vast VA system its own modernized EHR over the coming 10 years.
Cerner, working alongside Leidos and Accenture Federal Services in a collaboration known as the Leidos Partnership for Defense Health, has so far implemented an EHR system built around its Millennium commercial platform (and linked with an electronic dental record built by Henry Schein) at those four sites.
Next up: 23 more "waves" of three or so hospitals with a dozen or so ambulatory sites for the MHS Genesis initiative. Pending the eventual signing of a contract with the U.S. Department of Veterans Affairs, which is expected to happen soon, Cerner will also roll out a Millennium-based EHR for the VA, in some four-dozen phases over the next decade
For the VA project, it hasn't been confirmed who Cerner's partners would be, since a contract has yet to be finalized. But VA Secretary David Shulkin, MD, wants the DoD and VA system to be tightly unified, and so having Leidos and Accenture on board would certainly help with continuity.
"Obviously we still have to get to a contract, but we're anxious to do that and are working hard to do that," said Cerner President Zane Burke. "We haven't finished our teaming agreement, our partnership piece, we'll be announcing that soon, but it's a safe bet to say we plan to keep the band together."
In the meantime, Burke, says he's been pleased with the progress made during the pilot phase of MHS Genesis. His colleagues from Leidos and Accenture are too, and are looking toward the future as the rest of the sprawling DoD project plays out.
The initial goal was "to go from simpler to medium-complexity to high-complexity here at Madigan," said Leidos Group President Jon Scholl.
Along the way, there were "no surprises, but a lot of work," he said. "The checkpoint now is to step back and say what are the lessons learned, how do we change the process going forward so we can incorporate all those learnings and move forward from there."
The military's processes and protocols are unique, he said, "just like any hospitals' are unique. So the learning has really come down to clinical change management, how the system is to operate in best support of the troops and the facilities in which it operates in the DoD."
Accenture Managing Director for Federal Health Jim Traficant applauded the four DoD provider sites, each of which "owned the responsibility of being an initial operating capability (participant) and trying to help provide input to strengthen the process of what will happen downstream on behalf of the DoD. They're to be commended for their success as well as their input. I think both sides working together is a very good model for the good of the country."
Along the way in this complex process, clinicians and their workflow have been the lodestar in the initial phase of the MHS Genesis project, said Leidos Defense Health SVP Jerry Hogge.
"Prior to the awarding of our contract, we independently with our partners developed workflows that we thought would fit within the operation of the military health system," he said. "And the government did that privately on their side. Then when we were awarded the contract we got together and compared notes. And we found good alignment between those sets of workflows."
Of course, said Hogge, over two-plus years of working together, "there's been a lot of refinement of that: getting the workflows adjusted and tweaked to the exact way healthcare is delivered in each facility is one of the biggest focus areas of any deployment, either inside the federal marketplace or commercially. That's where a lot of our attention has been.
"And then training the staff. There are some unique elements to training in a military health environment because of the OPTEMPO (operational tempo) of the sites, and the way people rotate in and out of the sites. We've had to tweak our commercial best practice to adapt to a military health setting. But those have been key focus points for our team – getting the system in, while you're continuing to treat patients and not disrupting the treatment."
Now, with the addition of Cerner's VA contract adds to the scope and complexity of this project.
Secretary Shulkin is clearly keen to capitalize on the momentum of the MHS Genesis pilots, and asked this week asked Congress for $782 million to kickoff the Cerner implementation across the VA.
"We'll work with the Leidos Partnership for Health, and our respective clients, to really create the most effective and efficient rollout possible for the servicemen and women and the veterans, which likely is a geographical approach that we'll tweak as that goes forward," said Zane Burke. "We'll work hand in hand to make that happen."
Should these two projects be thought of as two distinct initiatives at this point, one for the DoD and on for the VA? Or is it now one massive undertaking from here on in?
"We have two clients, we're serving two customers, but it is one system," said Burke. "You've got to think about it as a single system that supports the both the DoD and the VA. It's obviously complex, what we're doing.
"It was already complex, and the VA adds additional elements to it, but the VA is going to start with the DoD system and use that work moving forward," he added. "We already work with multiple partners and again, some consistency pieces are important moving forward, making sure we're as synergistic as possible."
And that, said Burke is what the government is looking for: "How do they do this in an efficient and effective manner. And have it so the servicemen and women have access to their healthcare records in that geography, whether they're active-duty or retired."
Patient matching is at the forefront of the national Health IT conversation. Senators are urging the GAO to consider a national patient matching strategy, and the ONC and CHIME have both run patient matching competitions in search of a better approach.
It’s no secret that a new approach to patient matching is sorely needed. The average duplicate record rate within health systems is 20% and growing. And when exchanging health information between health systems, the patient matching error rate is upwards of 50%. These numbers are jarring, but more importantly they drastically impact patient safety, patient care, and business costs. Luckily, a next-generation patient matching approach exists that organizations can leverage in three simple steps to dramatically improve their patient matching.
Attend this webinar to learn about this next-generation matching approach, called "Referential Matching,” and to hear about the real-world successes that three large healthcare organizations have seen with Referential Matching.
CHIME revealed that it is suspending its National Patient ID Challenge.
After two years of work, the CHIME Healthcare Innovation Trust put the global competition aimed at incentivizing innovators to create a solution for ensuring 100 percent accuracy in identifying patients in the U.S.
“The CHIME challenge helped underscore the importance of patient identification and matching in fostering the interoperable exchange of health data, and the difficulty in addressing this perennial problem in healthcare,” said Ben Moscovitch, manager of health information technology at The Pew Charitable Trusts. “Pew is conducting research on ways to advance patient matching – whether through better standards for demographic data elements or increased patient control in having their records matched.”
Improving matching – and ensuring patients and clinicians have the information they need – requires collaboration across healthcare, including among health IT developers and healthcare providers, Moscovitch added.
The average duplication rate in a healthcare organization’s medical records is between 8 and 12 percent, according to the American Health Information Management Association. Duplicate medical records can result when a single patient has multiple records connected to them or when a single medical record has co-mingled data from multiple patients.
This is a serious problem in healthcare, and one that many believe can be solved with a national patient identifier, a single way for uniquely identifying an individual receiving healthcare in the United States. Industry associations including AHIMA, the College of Healthcare Information Management Executives, and the Healthcare Information and Management Systems Society all have worked toward solving the patient ID dilemma.
“We firmly believe that accurate patient identification is fundamental to patient care today and that innovation will lead to better, more affordable, more accessible and more equitable care,” said Russell Branzell, CHIME CEO. “Though we’ve made great progress and moved the industry forward in many ways through the challenge, we ultimately did not achieve the results we sought to this complex problem. We decided the best course of addressing this patient safety hazard is to redirect our attention and resources to another strategy.”
That strategy is to help develop a patient identification task force through its CHIME Healthcare Innovation Trust. CHIME says it is well positioned to bring together health IT leaders from the provider community and industry as well as policymakers and others to build a multisector task force.
But others have been working on the problem, too, and while they believe CHIME has done good work, they feel they also have much to contribute.
Some in the industry believe the news from CHIME along with work from the ONC offer a path forward.
“We’d like to thank CHIME because this competition has pushed the industry to explore whether things like biometrics and blockchain can truly solve our nation’s patient matching and patient identification problems,” said Mark LaRow, CEO of Verato, an identity resolution and matching platform vendor. “And it is clear now that the answer is no. The recent ONC patient matching algorithm challenge proved that algorithms are the right direction for solving patient matching.”
On another front, earlier this year, the Regenstrief Institute won a five-year, $1.7 million grant from the Agency for Healthcare Research and Quality for development and testing of automated patient identification approaches.
Officials at Regenstrief’s Center for Biomedical Informatics said they will use the funding to build on more than 15 years of work in matching patient records. And their researchers also will work with the Indiana Network for Patient Care, the largest inter-organizational clinical data repository in the country, to create and test new patient ID methods in a real-world setting.
“Matching the correct individual to his or her health data is critical to their medical care,” Shaun Grannis, MD, principal investigator for the new grant at Regenstrief, said in a statement. “Statistics show that up to one in five patient records are not accurately matched even within the same healthcare system. As many as half of patient records are mismatched when data is transferred between healthcare systems.”
Also this year, healthcare IT security company Imprivata partnered with Just Associates in an attempt to position its Imprivata PatientSecure tool as a top patient ID and data integrity tool for healthcare organizations. The partners said they will prevent misidentification by retroactively cleaning up patient data and proactively eliminating the creation of duplicate and overlaid medical records.
To avoid patient matching problems, Imprivata PatientSecure identifies patients at the source and launches a one-to-one link between a patient’s biometric and unique electronic medical record.
EHR vendor eClinicalWorks has been hit with a class-action lawsuit that alleges patients couldn’t trust their medical record’s accuracy due to flaws in the company’s software.
The suit comes just six months after the company was hit with a $155 million settlement to resolve a False Claims Act suit that claimed it gave customers kickbacks to publically promote its products.
The company did not immediately respond to a request for comment.
Kristina Tot -- in charge of the Stjepan Tot estate -- filed the complaint in the U.S. District Court in the Southern District of New York on Thursday. Tot is asking for $999 million in monetary damages for breach of fiduciary duty and gross negligence.
Stjepan Tot died of cancer, and the suit claims that “he was unable to determine reliably when his first symptoms of cancer appeared [as] his medical records failed to accurately display his medical history on progress notes.”
Further, the lawsuit claims that millions of patients have compromised patient records, as eClinicalWorks’ software didn’t meet meaningful use and certification requirements laid out by the Office of the National Coordinator.
These patients “can no longer rely on the accuracy and veracity” of their medical records as it stands in eClinicalWorks EHRs. According to the suit, more than 850,000 healthcare providers use eClinicalWorks software.
In the complaint, Tot lists a wide range of the company’s shortcomings including failure to reliably record diagnostic imaging orders; failed audit log requirements; failed data portability requirements; and failure to satisfy required certification criteria, among others.
eClinicalWorks settled with the Department of Justice in May for knowingly falsifying meaningful use certification, which allowed for fraudulent incentive payments to providers. It was the first case of its kind. But some have suggested eClinicalWorks was not the only vendor to shirk certification criteria.
As a result, DOJ demanded eClinicalWorks transfer its data to rival EHRs for free and hire an independent watchdog for the company.
The lawsuit was first filed by whistleblower Brendan Delaney, who was a software technician at the New York City Division of Health Care Access and Improvement at that time.
As European healthcare providers deploy some of the same big-ticket technologies as their American counterparts, notably EHRs, patient engagement and eHealth tools, many are operating with tight IT budgets.
“Health IT is not sufficiently funded and supported in Europe,” said Robert Brauer, HIMSS Analytics Research and Quality Assurance Coordinator with HIMSS Europe.
Sixty-two percent of the health IT workers who participated in HIMSS Analytics Annual European eHealth Survey, in fact, said their shop has an insufficient budget for 2017 and 2018. Even though that is down from 68 percent in last year’s survey, HIMSS Analytics said it points to a strong need for more tech investments.
“Some countries like Italy or Spain are going through financial crisis or just overcome those,” Brauer said. “For Germany I also could confirm the lack of central direction and support toward a strong eHealth Agenda.”
Funding is the biggest obstacle in the UK, Austria, Ireland and Germany. But Spain, the Netherlands and Nordics ranked patient self-empowerment and self-management as the top challenge, while Italy cited interoperability standards and Switzerland named EMR implementation as its highest hurdle.
“You do have countries which are doing pretty well in terms of EMR adoption like Turkey, Spain, Netherlands and first of all Denmark or Estonia,” Brauer said.
European hospitals’ list of challenges invariably rings familiar to many American hospital IT pros, as will the top priorities HIMSS Analytics found for the year ahead: EMR implementation, eHealth and patient engagement, and a desire to develop leadership skills.
Along with the similarities, however, there are substantive distinctions between the U.S. and Europe.
“Many European countries have their own agendas, budgets and issues in terms of digitization,” Brauer said.
Below is the full data, courtesy of HIMSS Europe: