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    Banner Health is running into problems as it works to move two hospitals it acquired in 2015 from the University of Arizona from an Epic electronic health record installation onto a Cerner EHR. 

    “On October 1, our transition to Cerner began in two academic medical centers,” said Banner Health spokesperson Jennifer Ruble. “While EMR implementations are always challenging, our specific challenges have included issues with slowness and workflow delays that have caused longer than normal patient wait times.” 

    Ruble explained that Banner Health acquired the University of Arizona Health Network in March 2015, which consisted of University Medical Center Tucson and University Medical Center South, both of which were running on Epic. Since Banner Health was already a Cerner shop the plans was to consolidate the new hospitals onto Cerner.  

    Banner, a 28-hospital integrated healthcare system based in Phoenix had planned to complete the migration of the two acquired UA hospitals to a Cerner platform by 2018.

    When Banner Health Senior Vice President and CIO Ryan Smith talked to Healthcare IT News about the $45 million project in September 2015, he anticipated that putting all the hospitals on the same EHR would in the end both save money and enable clinicians to deliver higher-quality care.

    "There's significant cost savings by consolidating these two systems down to our single system," Smith said. "Even taking into account the sizable investment that the former organization had made in that Epic environment, the structure of our relationship with Cerner is actually very cost effective for us to make this migration." 

    Banner’s chief clinical officer John Hensing, MD, told the Arizona Star that the Cerner migration has thus far been a “painful period,” but added that performance degradation can happen when switching to any new application because transitioning systems is a complex undertaking. 

    “We view this as a temporary situation and have increased our level of support, training and communication guided by the feedback we are receiving,” Ruble said. “As we become more proficient in this new technology and associated workflows, we know we can deliver a high level of service and all the benefits of a system-wide EMR platform.”

    To that end, Banner Health has boots on the ground providing on-site support to expedite the migration to Cerner, Ruble added. 

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

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    Banner Health hits snags migrating two hospitals from Epic to Cerner EHR
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    Banner Health hits snags migrating two hospitals from Epic to Cerner EHR
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    New EHR has slowness issues and workflow delays that are causing longer patient wait times, a Banner spokesperson said.

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    A new wave of speculation from industry analysts is putting Apple in the spotlight over its supposed plans for creating a new sort of EHR – the soul of a new device, so to speak.

    The new speculation is fueled by the patents Apple has recently secured. 

    [Also: Apple reveals plans to put health records on the iPhone]

    Analysts reason that Apple may be poised to enter the mobile healthcare monitoring device, EHR, and healthcare data storage markets.

    Healthcare IT News reported in June that Apple was working to put health records on the iPhone, where iPhone users could easily access their medical records, including lab results, medical tests, appointments and other healthcare records in one place.

    The more recent efforts appear to go beyond healthcare records, however.

    [Also: Timeline: How Apple is piecing together its secret healthcare plan]

    Patent US 9723997 B, obtained by Apple back in August, for example, is an electronic device that computes health data of the user based upon sensor data regarding the received light.

    In some implementations, the electronic device may also include one or more electrical contacts that contact one or more body parts of the user.

    [Also: Could Amazon or Apple actually make a dent in the EHR market?]

    As described in the patent, “in such implementations, the health data may be further computed based on the electrical measurement obtained using the electrical contacts.

    According to the patent description: “'Electrical measurements may be used to measure heart function, compute an electrocardiogram, compute a galvanic skin response that may be indicative of emotional state and/or other physiological condition, and/or compute other health data such as body fat, or blood pressure.”

    [Also: Decide for yourself: Will Apple and Amazon enter the EHR market?]

    Apple is not the lone tech giant showing an interest in healthcare. Amazon, too, has kept a close eye on the market.

    Back in July, Amazon started a secret lab at its Seattle headquarters to explore business prospects in the healthcare sector, including EHRs and telemedicine. At the time Amazon was reportedly considering developing an EHR platform as well as telemedicine and health apps for existing devices, such as its Echo smart speakers, which connect to a personal assistant, called Alexa. It dubbed the project “1492,” the year Columbus first landed in the Americas.

    Later, it appeared that Amazon was looking into ways to break into the pharmaceutical sector.

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

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    Is Apple poised to enter EHR market? New patents have the industry buzzing
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    Is Apple poised to enter EHR market? New patents have the industry buzzing
    Newsletter teaser: 
    Apple is not the lone tech giant showing an interest in healthcare: Amazon, too, has kept a close eye on the market.

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    When hospitals and health systems can reduce variation in care, it can save lives and reduce costs. The concept is getting a lot of attention from larger health systems today because unnecessary variation is bad for patients and causes wasted expense, but can be addressed with electronic health records systems and, most important, clinical pathways.

    By embedding Epic’s clinical pathways tool into its EHR, for instance, health system Mercy saved $27 million and 480 lives. Pathways help the hospitals provide consistent, standardized care by outlining treatment for patients with common medical conditions and procedures. Pathways are divided into steps, based on timeframe or patient condition, which organize orders and clinical documentation.

    [Also: Healthcare data: A beast best tamed by machine learning?]

    Here’s a look at what’s fueling Mercy’s success and what Penn Medicine and Cancer Treatment Centers of America are also doing with clinical pathway tools. 

    Putting clinical pathways to work

    Cancer Treatment Centers of America and Penn Medicine are also deploying pathways technologies. 

    Penn Medicine is using its Big Data analytics program to help identify the best ways to predict illnesses, treat patients and, in turn, to continually enhance its clinical pathways.

    Penn brought together thousands of variables together, including vital signs, lab results and medications. It fed these variables into a real-time matrix upon which it could apply algorithms in order to make predictions and better its clinical pathways. 

    [Also: Is Apple poised to enter EHR market? New patents have the industry buzzing]

    A clinical and data science team built a dashboard that reports on how care teams are working with clinical pathways, how to reduce readmission rates, how to improve quality of life for patients, and more.

    Cancer Treatment Centers of America, for its part, uses a custom technical solution that enables eviti, a NantHealth clinical decision support system, access to clinical workflows in the Allscripts Sunrise electronic health record. The Clinical Pathways program is designed to help inform the cancer treatment process, without interrupting the physician’s clinical workflow.

    The direct interface of the clinical operating system (NantOS) was built with the input of hundreds of oncologists across the nation and holds a comprehensive collection of evolving cancer care data, the vendors said.

    The resulting Clinical Pathways integrates the latest cancer research available, treatment regimens and complementary therapies into the Allscripts Sunrise EHR, giving oncologists the ability to create a curated list of care protocols, the vendors explained.

    How Mercy’s clinical pathways progressed

    Mercy began piloting its heart failure clinical pathway in three facilities in 2013. Following this initial pilot, it expanded the pathway pilot program across Mercy’s four states with limited use. It was fully implemented in the beginning of July 2014.

    “Mercy built all of its clinical pathways within the EHR to take advantage of tools in a provider’s typical workflow, but with the added benefit of evidence guiding care delivery,” said Ursula Wright, executive director of clinical performance acceleration at Mercy, which uses the EHR and clinical pathways feature from Epic.

    As the care team is documenting in a patient’s chart, the information entered into the EHR, such as diagnosis, assessments and lab values, determines which evidence-based clinical pathway is recommended to the physician for that patient. It could be the heart failure pathway or one of 40 other pathways Mercy now has in use today. In this way, the pathway appears seamlessly integrated with the EHR.

    “Once the physician is presented with the recommendation to place the patient on the pathway, she’s provided with quick links via a recommended order set or a best practice alert,” Wright explained. “With one click, she’s taken into her typical workflow for entering orders. These orders are both evidence-based and rules-based using information about the patient available in the EHR.”

    The initial recommendation might read: “This patient has been identified as a candidate for use of Pathway X. Please select Accept below to place the evidence-based orders for care of Condition A, including the pathway.” Once accepted, the physician is shown tools, such as the order set, that present orders designed with evidence-based standards and rules.

    These unique order sets have been built to display specific orders based on the patient’s clinical characteristics. The pathway itself is initiated based on the order and it contains outcomes, tasks, education and other elements that drive the patient’s care.

    The pathways were created, and are continuously optimized, by Mercy’s clinical experts. This could be Mercy physicians, nurses and any care team member who can contribute to the effectiveness of the pathway. The design is guided by regular review of evidence and data analysis drives decisions on the recommended treatment course.

    About those patient lives and money saved

    Approximately 700 patients a month are admitted with heart failure across Mercy’s 40-plus hospitals in four states. Before the pathways work began, Mercy’s inpatient mortality rate for heart failure was 5 percent, or approximately 35 patients a month.

    With the use of the heart failure pathway, the inpatient mortality rate dropped to 2 percent or approximately 15 patients. That equates to about 20 patients each month, roughly 240 lives a year or about 480 lives saved over the course of two years from July of 2014 through June of 2016.

    “Mercy saved $27 million by reducing the direct variable costs of patient care through the use of pathways,” Wright explained. “For patients treated on one of Mercy’s 40 pathways, the cost per case was between $800 and $1,000 less when compared to patients not treated with a pathway. This represents a total savings of $10 million in Fiscal Year 2015 and $17 million in the first three quarters of Fiscal Year 2016, or July 2014 through March 2016.”

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

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    Why integrating clinical pathways into EHRs can save millions
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    Want to save hundreds of lives and millions of dollars? Integrate clinical pathway tools with your EHR
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    Penn Medicine and Cancer Treatment Centers of America are deploying clinical pathways technologies and Mercy already saved 480 lives and $27 million by connecting them with its Epic electronic health record.

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    Beth Israel Deaconess Care Organization is a value-based network comprising eight hospitals and about 2600 providers in eastern Massachusetts.

    It's grown and changed quite a bit over from its early days as Beth Israel Deaconess Physician Organization, says its chief information officer Bill Gillis. Over the past decade-plus or so, it has evolved into a joint hospital-physician venture, with each side having equal ownership of its governance.

    In 2011, BIDCO signed on as a Pioneer ACO, with all the shared risk that entails, and quickly became one of its top performers. It's build on that success through similar ventures with commercial plans, MassHealth ACO, Medicare Shared Savings Program and others.

    [Also: Beth Israel to unveil new population health system]

    When it comes to value-based contracts, "we really believe that having a true picture of real-time clinical data is one of the cornerstones," said Gillis.

    That's easier said than done, of course, even for a longtime technology leader such as BIDCO, where 100 percent of its network has an EHR, and most providers have been using them since long before meaningful use.

    The challenge of that, is that in organically growing, BIDCO is "a mish-mash of a lot of different systems," he said. "In our network, we have 45 different vendors that we deal with. But the reality of that is we have about 150-plus installs of different versions, so it gets to be a bit of a crazy game."

    Early on, said Gillis, "I'll be the first to admit: It was my naiveté that I thought, 'We're in the meaningful use program, and meaningful use requires all EHR systems to be interoperable, so if we just allow people into the network and just say they have to be on an MU-certified EHR, boom, we'll have interoperability, right?' Well, we all know how that really works out."

    Still, BIDCO managed, with with great effort, to wrangle all those different data streams into something usable.

    "We had a claims data warehouse, we were aggregating all of our EHR data into a clinical data repository, which was a key component," he said. "We started doing what we call our QDC, our quality data center, we began working with that in 2010, to seed a system of raw clinical data out of EHRs, as a way to say let's get all of this data in one place and figure out a way we can aggregate it and normalize it.

    "As we started to grow into these programs we were looking at the reality of getting data out of all of these systems and how to really do something with it – make it usable," he added. "That's where the real challenge started to come in. An analogy I use a lot is we went out in the community, we connected all the pipes, and then we turned on the water, but the water wasn't really drinkable at that point."

    BIDCO had five or six different data repositories from which it tried to pull different information, normalize it and "use it in a way that we could sort of tell a story," said Gillis. "But by its nature it was prone to inaccuracies and not really in a place were we could distribute it out to our members and say with confidence, here's your data – here's how you're doing on quality, here's how you're doing with utilization. We needed to come up with a different way to do that."

    With the rollout this summer of a population health platform from Arcadia Healthcare Solutions, BIDCO has helped solve many of its most pressing data management challenges.

    The tool enables easier aggregation and analytics, validating, normalizing and integrating disparate data – EHR, lab, imaging, claims – which are combined into reports delivered to BIDCO's pop health teams and providers, helping them assess their performance, spot high risk patients in need of complex care management and better address prevention and wellness.

    "It gave us the opportunity to centralize this information, pull it all into one place and take advantage of all this massive amount of data that everyone is generating now," he said. "It's been normalized, it's been aggregated, it's been validated for accuracy. All of the data elements are mapped, so when we're talking NDC code or RxNorm code, we're talking about the same drug. That was a vision we had, and that's where we are now."

    Of course, implementing such a large enterprise system is a big undertaking, and BIDCO chose to do it on a shorter timeline than it otherwise might have. So beyond the technology challenges, effective change management processes were key.

    But Gillis says the system is now at a place where providers are much more confident in the platform: "As they see the data – an example is we're able to pull in data elements like ADT information from across our network – they take advantage of it now," he said.

    "Our goal is to get to a place where, with a lot of analytics, the power of big data will be for our end users," he added. "Our docs, our care managers, the practice managers and the staff to go right in and run whatever report they want, or take a report we've built for them and drill down into any level they want to get it to. To make it as self-service as possible. That's our goal. I'd say we'll probably be there around Q2 of next year. But it is live now, and people are using it, and for the most part very happy with it."

    Still, in a perfect world none of this would have had to be this challenging, said Gillis, 

    "If we want to look at value-based care and contracting – really looking at reducing cost and better health – we have to come up with better standards for all of these systems to interoperate and communicate, as well as having the payers developing metrics where we can deliver information on them to show how we're performing in contracts," he said.

    "We have seven different risk contracts and seven different sets of quality measures we have to deliver on," Gillis explained. "While they're all generally based on HEDIS, a hemoglobin A1c compliance from one payer to another can be slightly different. An EHR vendor isn't going to do that. They're not going to show, this is your Blue Cross data and this is your Tufts data. They're just going to give you data on A1c. And then we have to take that to see if it meets the measure or not.

    "It would be great to get to a place – this is my Christmas wish – where maybe there's 100 or 200 measures that all the payers agree on: CMS, Blue Cross, Harvard Pilgrim, they all agree that these are the 200, and then those payers can pick the ones that represent the population that they're wanting us to manage for them," he said.

    "And then vendors can build their systems to be able to report on that data in a way that's standardized, instead of us getting data from 45 different EHRs, validating it, normalizing it and then generating reports representing how our providers are doing with different payers."

    That's a tall order, Gillis admits. But it's better than what's often the status quo. "It's a big burden that right now is put on BIDCO – but I think could be distributed in a way that makes it more manageable for everybody."

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

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    Short Headline: 
    ACO wrangles data from 45 different EHRs for real-time analytics
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    ACO wrangles data from 45 different EHRs for real-time analytics
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    The CIO of Beth Israel Deaconess Care Organization says its population health platform has helped manage disparate data, but he still wishes vendors and payers would help manage the burden of value-based care.

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    Solutionreach
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    According to a recent industry survey conducted by Solutionreach, nearly one in three patients are at risk of leaving their healthcare provider in the next two years. One in eight have already left, and not just because of changes to insurance or a move. Nearly 40 percent left because of a poor experience. Practices can’t continue trying to engage with patients in the same old ways. It’s time for a change if successful patient retention is the end goal.

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    Using Patient Preferences to Boost Retention and Satisfaction
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    Using Patient Preferences to Boost Retention and Satisfaction
    Newsletter teaser: 
    According to a recent industry survey conducted by Solutionreach, nearly one in three patients are at risk of leaving their healthcare provider in the next two years. One in eight have already left, and not just because of changes to insurance or a move. Nearly 40 percent left because of a poor experience. Practices can’t continue trying to engage with patients in the same old ways. It’s time for a change if successful patient retention is the end goal.

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    Recently resigned chief executive Jeffrey Immelt on Thursday said GE in the past tried to acquire Epic and Cerner at different times. 

    Immelt, who retired as director and chairman of the General Electric’s board of directors in October 2017, recounted at Healthegy’s annual Digital Healthcare Innovation Summit in Boston discussions with Faulkner including a suggestion that GE and Epic might work together or perhaps GE could acquire parts of Epic’s business.

    [Also: Epic reveals R&D spending outstrips Apple, Google and its competitors]

    Faulkner, who is known for her devotion to the business she launched in 1979 – didn’t have to think twice. “She just said, ‘No, no interest,’” Immelt said, according to an Xconomy article. “It was a five-minute meeting – perhaps the shortest in history.”

    Faulkner likes to point out that Epic software is developed in-house. There have been no acquisitions of other companies. She claims that 50 percent of the privately-held company’s operating expenses are invested in research and development, and 190 million patients have a current electronic record in Epic.

    Immelt also said he considered a deal to acquire EHR giant Cerner. He dropped that effort, though, because the 2 billion price tag under discussion was too expensive. 

    Immelt did not reveal when he had been in talks with Cerner but Cerner’s market valuation today is $23.38 billion.

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

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    GE once tried to buy Epic and Cerner. It didn’t go well
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    What happened when GE tried to buy Epic and Cerner and was shut down within 5 minutes
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    Former GE CEO Jeffrey Immelt has just revealed the decades-old rebuff to buy the EHR giants.

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    The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT offered a glimpse at behind-the-scenes work they are doing together to reduce the burden EHRs place on doctors, nurses and other technicians as well as working to eliminate physician burnout. 

    “One of the first things we said is ‘this cannot be PQRS 2.0 or meaningful use 2.0,’” CMS director and chief medical officer Kate Goodrich said Thursday during an ONC panel discussion. 

    [Also: Seema Verma promises CMS is focusing on interoperability, patient empowerment]

    That’s 2.0 as in the Web 2.0 vernacular, for the record, and not to be confused with meaningful use Stage 2. 

    Goodrich noted, for instance, that her team is working to achieve a more customer or user-centric design approach in the development of everything from the website on, including backend IT operations, policy development, communications and a new service center.

    “We at CMS had to develop some new skills,” Goodrich said. “One of the skills that we have been developing over the past two years is human-centered design. We are trying very hard to spread those skills across the agency for everything we do from survey and certification to quality improvement, to value based purchasing.”

    ONC Chief Medical Officer Thomas Mason, MD, works with Goodrich’s team exploring ways to decrease both administrative and regulatory burden caused by today’s crop of electronic health records. 

    As a part of the ONC certification program, health IT developers that certify to the 2015 edition EHRs are required to use a user-centered design process for the development and the testing of their software. Also, safety enhanced or user-centered design criteria were built into the certified health IT product list
    The developer community is working to incorporate the human- centered design elements into the software development process, he said.

    Mason pointed out that there are a number of design decisions that occur during the EHR implementation process that significantly impact both usability and safety. ONC conducted an environmental scan, literature review and gathered input from the clinical community on what are these issues and challenges around usability.

    Mason pointed to AMAs STEPS Forward initiative as one example.

    “We incorporated the AMA's STEPS Forward modules. These are practice transformation modules that are designed to help clinicians with strategies and steps to improve practice efficiency as well as help practices achieve the quadruple aim,” Mason said. “There is a wealth of resources and tools to help with workflow and techniques and strategies around a variety of care settings that are very helpful.”

    CMS and ONC shared these insights at the ONC Annual Meeting, Nov. 30 to Dec. 1 in Washington DC.

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

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    CMS chief medical officer calls for human-centered EHR design
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    CMS chief medical officer: We must develop new skills for EHR usability and human-centered design
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    That goes for the way CMS serves its constituents as well as how it work with ONC in thinking about more usable and less burdensome EHRs.

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    How close are we to precision medicine being commonplace, widespread – perhaps even the standard of care? How near are we to an environment where genomic advances are routinely part of the equation when it comes to treating patients?

    "The changes are happening so quickly," said India Hook-Barnard, associate director of precision medicine at University of California San Francisco. "I think the world is going to be a very different place in five years."

    Suddenly we seem to be nearing a critical mass where precision medicine is no longer just a buzzword but is actually widely integrated into the way physicians deliver care.

    "In my opinion, we've well gone over critical mass," said Joel Diamond, MD, co-founder and chief medical officer of Allscripts subsidiary 2bPrecise.

    "I'll give you an example. I was seeing patients in my own practice a few days ago, and a young woman came in for a regular physical exam. She was a nurse. I asked her about pap smears, mammograms – normal screenings.

    Since her mother and two aunts all died of breast cancer and another relative passed away from ovarian cancer, Diamond’s patient was naturally concerned about getting BRCA tested and a bit nervous. Knowing what we know today, it would be unconscionable for a physician to not counsel such a patient to undergo genetic testing, said Diamond.

    "The chance of that woman not having a BRCA mutation is almost zero," he said. "And if she has that mutation – and she has a daughter and a sister – she has an upwards of 80 percent chance of having breast cancer and a 40 percent chance of having ovarian cancer."

    The challenge, however, is that such a test would not necessarily be prescribed by a physician who's not up-to-speed with the new wave of genomic insights. And even if it was, there's no guarantee that the test is easy to order, and there's little chance the insights it revealed – most likely tucked away in the patient's electronic health record as a PDF – would be available to other clinicians along the continuum of care. And there really is no methodology for screening genetic tests.

    Long story short: Despite the massive leaps forward in knowledge since the completion of the Human Genome Project in 2003, the healthcare industry has yet to grapple with the big changes to people, process and technology needed to truly capitalize on it.

    From EHRs to interoperability to clinical decision support, healthcare as an industry does not have the technological infrastructure for precision medicine in place yet.

    But that's all about to change — and quickly.

    Just what is precision medicine, anyway?

    Before exploring this topic further, it's worthwhile to settle on a definition of just what precision medicine is. As defined by the National Institutes of Health, it's "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person."

    "It's about genomics, but it's certainly not only genomics," said India Hook-Barnard, director of research strategy and associate director of precision medicine at University of California San Francisco.

    "To my mind, it's very much about the data," added Hook-Barnard. "A variety of different kinds of data that impacts health, and then being able to analyze and use that. It's genomics, but it's also your microbiome, your metabolome, the environment and socioeconomic factors. Being able to measure how often you exercise, how do you sleep, the quality of your water and your air. Those things can have huge impacts on your health and we all know that.

    The interplay of all that information with individual’s genomics can, in turn, enables researchers and clinicians to gain a better understanding of what therapies or interventions might be most appropriate for a particular individual.

    “That's where we want to try to get," she said.

    EHRs are not enough

    Healthcare is moving toward a precision medicine future state faster than many might think. According to HIMSS Analytics, "precision medicine usage has tripled in the last five years." More than 25 percent of U.S. Hospitals have recently purchased precision medicine technology and 22 percent have gone live with an installation.

    The biggest growth area for precision medicine has been academic and specialty hospitals, which together represent 18 percent of inpatient sites, HIMSS Analytics said more than half of such facilities have precision medicine technologies in place.

    That's unsurprising, given that academic medical centers have both the mission and vision to innovate on leading-edge treatments, and the resources to build out the IT infrastructure necessary to handle the demands of precision medicine. Because EHRs are not enough.

    "Not only are they not enough but they shouldn't be enough," said Diamond. "EHR companies are very big on saying they're compliant with Smart on FHIR technologies. And that's all great. I applaud that, it's wonderful, at least there's a standard for getting the information in there.”

    Or put another way: The good thing about EHRs is you can put just about anything in there but the bad thing about EHRs is you can put just about anything in there.

    "The fact that you could insert genetic info in an EHR doesn't mean it's in a form that's acceptable and usable for doctors at the point of care,” Diamond said. “I don't think it should be in the EHR.”

    When a genetic panel, exome or a full genome is ordered, for instance, the return will likely include hundreds or maybe even thousands of variants of unknown significance.

    “Science has not yet determined whether they're pathological or not. To store those in the EHR, you'd have to be crazy,” Diamond said. “I would not want to store something that today might be pathological, and tomorrow a paper comes out and says that it is, and then I'm responsible for digging it up and notifying the patient. There's some danger in the EHRs being the repositories for that kind of information."

    From her perspective, Hook-Barnard sees EHRs paying lip service to the new avenues of precision medicine and working on making it happen, by and large, as glorified billing systems.

    On the other hand, "there's a lot of innovation in the consumer space and in a lot of cases moving more rapidly," she said. "If EHR vendors don't make some changes, they may get bypassed."

    Precision medicine architecture emerging

    While many others in the health IT industry agree that electronic health records and today’s existing technologies are not robust enough for the large data sets and analytics that precision medicine will require, Beth Israel Deaconess Medical Center CIO John Halmka, MD, said new innovations will happen outside the EHR.

    “We will get beyond MU, the last 8 yrs of clinician burden, and connect an ecosystem around our EHRs,” Halamka said. “We can turn EHRs into your friend rather than your foe.”

    Halamka said an architecture is already emerging to advance precision medicine: Apple’s HealthKit running on a smartphone that uses FHIR APIs to link to EHRs.

    Beth Israel’s BIDMC@Home is one such example. Describing the app as a Facebook-like next-generation portal, Halamka said it includes a patient care plan with information about diet, medications and exercise.

    “The app takes data showing in the EHR and offers reminders on variance, such as ‘your weight went up 7 pounds and you’re a congestive heart failure patient, you’re accumulating fluid and could end up in the ER soon,’” Halamka said. 

    Data, data everywhere

    Expect to see more apps and tools like that in the years ahead at providers large and small. But in the meantime, some big hurdles remain, beyond technology challenges.

    Most especially, there's a data problem. To wit: How much is there, where is it, who has access to it, how does it move from one clinical setting to another?

    "All of these tests are being ordered Wild West-style. It's unusual to have policies around what they're ordering, how the information is recorded, where it's going,” Diamond said. “It's multiple labs, multiple different forms – PDFs, Word docs, etc. – sitting in proprietary document folders in the EMR. Because people haven't put any methodology around it.”

    Such a methodology that includes understanding who’s ordering which tests, and where, and knowing where it all exists, would be a logical first step to putting some efficiency in the process, Diamond noted. Add to that the profusion of patient-generated information that factors in when tailoring treatments and the problem becomes that much more acute.

    "People are increasingly going to have their own data that they're going to want to use and bring to their physician," said Hook-Barnard.

    There's IoT data, Fitbit insights, information from your iPhone or other mobile apps, sequencing and genomic results from consumer-focused tests such as 23andMe.

    The challenges involve "being able to connect the electronic health records, and thinking about how to get the data in and out of the EHR,” Hook-Barnard said. “How does that data get into the patient's record? And then how is that going to be used so the physician can access it?"

    Make precision med a focus of CME

    Doctors have some work to do on this front too.

    With the field of genomics progressing exponentially, many clinicians – a good number of whom probably learned little if anything about precision medicine techniques – will need to get up to speed quickly (and stay up to speed) as the scientific breakthroughs keep coming.

    Diamond said its time for physicians to start educating themselves. That means knowing what genetic variants to test for and when, whether the results of those tests are actionable, sometimes even what a test looks like and how it's performed.

    "I'll bet if I asked 80 percent of doctors if they know about BRCA testing they would – but then if I asked, 'How do you order the test?' they wouldn't," said Diamond. "'Do I order it from Quest? Do I do a mouth swab? Do I use blood? I think I'll just refer them to a genetic counselor' – which is probably the wrong answer."

    He suggested, instead, that doctors acquaint themselves with the website of the American College of Medical Genetics and Genomics, which publishes a list of the genetic variants that are clinically actionable.

    "At the very least they can start with that list of 80 or 85 or whatever they're up to now," he said. But beyond that learning more about pharmacogenomics, for instance, "is an easy one. It doesn't require people to go back and revisit medical school criteria and start learning all these complicated nomenclature.

    "We all know how to look at drugs and find out if people are allergic to those drugs or there's a drug-drug interaction, or drug-condition interaction," he said. "It's not a giant reach for us to understand that some of those things also have a genetic determinant to them and we should start looking at that."

    Patients need education too

    Patients and consumers also have a steep learning curve ahead, said Hook-Barnard, who sees a need in the near term, for professionals help them separate the proverbial wheat from the chaff.

    "I think there will be a role in helping patients understand the data that they have, what's meaningful and what's not," she said. "In the consumer space, which of those things are real, and useful, and which of them are junk science?

    "In some of those cases, it's going to be a real challenge," she added. "When is a patient bringing in information that really does need to be considered and you can help them do that, versus when are you very legitimately able to say, 'We're not ready to use this effectively yet,' or 'This company is not doing anybody any favors' and it's more of a snake oil situation. I think there's going to be some challenges for physicians during that transition."

    Beyond the risks of fly-by-night companies peddling tests that might only muddy the waters, it's worth remembering that not every potential genetic mutation should necessarily be tested for – and that, when those tests are performed, the resulting information can sometimes be complicated to process.

    "People are feeling empowered: Knowledge is power," said Jessica Langbaum, principal scientist at Phoenix-based Banner Alzheimer's Institute. "Individuals are not always aware of the considerations they should keep in mind before deciding to learn their genetic risks for certain diseases, such as Alzheimer's.”

    Langbaum pointed to emotional considerations, including how someone might react to receiving this kind of information.

    "People should take a step back and ask, by having this information, what would it do for them – what would it change in their life, would it help them in any way? Are they actionable results?” she added.

    Physicians will also have to be ready to help patients interpret the result of these tests as more and more people make use of direct-to-consumer testing, she said. "Even though the companies are trying to make the information clear to consumers, people are still confused about their risks for actually developing the disease."

    And in some cases, it might be better not to know. For instance, "we don't advocate for people learning their genetic risk of Alzheimer's disease, because outside of perhaps participating in a clinical trial, there's nothing we can tell them to do differently," said Langbaum. "There's no medication they can take. We'd only suggest they learn that information if it's something that would help them make a choice about participating in a research study or something along those lines."

    That said, on the larger question about precision medicine, it's here and gaining steam every day.

    "It's happening," said Hook-Barnard. "Now it's a question of how do we do it well, and have patients engaged in it as partners. Those technologies – a lot of them are already at work in other industries and now it's just a matter of having them a part of healthcare and how we can use them to improve health."

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

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    Trying to predict what federal IT budgeting and expenditures will look like in the year ahead is difficult, if not impossible. So we asked Chris Wiedemann, market intelligence senior analyst at McLean, Virginia-based immixGroup, a value-added distributor of public-sector enterprise technology, for his perspective on what spending and resource allocation might look like on just one government health IT project in the year ahead – albeit arguably the biggest one.

    Even that – the U.S. Department of Veterans Affairs choice of Cerner to modernize its longstanding VistA electronic health record – is, at this moment at least, hard to reckon with any certainty.

    For one thing, there's still no contract yet, even though VA Secretary David Shulkin, MD, tapped Cerner as the sole source vendor for the project back in June.

    [Also: Shulkin asks Congress for $782 million to jumpstart Cerner EHR project for VA]

    Cerner President Zane Burke told Healthcare IT News three weeks ago that the two sides are working toward a contract finalization, but didn't offer a timeline: "we're anxious to do that and are working hard to do that," he said.

    "We've heard that promise that there would be a contract soon twice already by my count – once in September and once again in October," said immixGroup's Weidemann. "Obviously, there was the CliniComp lawsuit, so it's been a bit rocky. But my guess would be that you would see an award early in the new year, in January. But that's just a guess.

    In the meantime, "from a market trend standpoint, as far as federal health IT spending goes, we're keeping as close an eye as everyone else is on the Cerner contract award, whatever the final system design and system architecture ends up looking like," he said. "Because I think that's what's going to shape the health IT market in this fiscal year."

    [Also: Cerner DoD overhaul coming out in waves; VA deal means 'single system' approach]

    Even if a contract were to be announced tomorrow, however, a few wild cards in Washington could potentially slow down the Cerner VA deal's forward momentum, said Weidemann

    For one thing, "I think that a shutdown after Dec. 8 is likelier than I thought it was even a few weeks ago," he said. "It seems like the things I was sort of waving off as political posturing from Congressional Democrats and the White House, they actually look like they're a little more entrenched than I thought they were."

    A government shutdown of, say, two weeks "would have a pretty significant knock-on effect for a project like the Cerner VistA replacement, just because of all the upfront work that's required to do that, and the amount of upfront capital investment that would be required," said Weidemann. 


    "What I think we can infer from the last government shutdown is that for each day that that drags on, things like a full-year continuing resolution or a relatively clean omnibus without a lot of hot-button appropriations issues one way or another, will start to look more appealing for each day that they government is closed," he added. "Certainly a shutdown would be a real wrench in the works."

    Another thing to consider: Despite President Donald Trump's lofty words in June – he called the VistA modernization deal "one of the biggest wins for our veterans in decades," and said Cerner would help solve the VA's interoperability challenges "once and for all" – "it's hard for me to get a read on just how high a priority this kind of system modernization is for this administration," said Weidemann.

    "The sense that you get just from the coverage is that they have other issues from an appropriations standpoint that they care about more."

    What if, for instance, the funding necessary to get the project off the ground were to be used as leverage for another project the president is truly passionate about?

    "You could end up seeing – and I don't know that this is likely but it's certainly possible – that full-funding for the VA modernization becomes something of a bargaining chip in return for border security investment or hiring at Immigration and Customs Enforcement or something like that," said Weidemann. "That would be another speed bump."

    Size, scope and cost of VA project still TBD

    Presuming there no unforeseen political shenanigans in the Nation's Capital, however, the VA deal will move forward as planned, very soon. And when it does, the sheer size and scope of the project will have a gravitational pull of its own over other areas of health IT, said Weidemann – even if we still don't know just how big it will be.

    "What I keep coming back to is, assuming a perfect world where there are no more hold-ups in the contract award, no more significant appropriations issues, a lot of this will hinge on how much the VA, how much stakeholders on the health IT side are bought into this commercial-off-the-shelf migration vision and how much they're willing to give up of their existing or legacy solution or code base," he said.

    "VistA at its core is an EHR platform but there's a significant amount of support functionality that's built into that. Do you replace that core EHR with Cerner but keep the existing support applications, custom applications and code that's been built on top of that for things like logistics management and supply chain for pharmaceuticals? If the answer to that is yes, that's interesting to me as a general COTS vendor, and if the answer is no, that you want to go COTS there as well, that opens new angles and new opportunities.

    "If I were someone who was previously locked out of VA, I would be paying attention to what that system design and architecture looked like," Weidemann added. "There's the potential here that the department wants to move more fully into the COTS space than they have in the past. And that it goes beyond core electronic health records."

    A lot of that might depend on how much money the VA is actually able to spend on the project. Secretary Shulkin asked Congress for a substantial chunk of change this past month – requesting that it redirect a total of $782 million from the 2018 fiscal budget: $690 million from medical care and $92 million from IT projects.

    He did so even while recognizing that limitations inherent in the continuing resolution governing the budget meant that just $324 million from the former and $50 million from the latter could be disbursed right away. But that amount is the minimum necessary to start work on the project, Shulkin said.

    "My expectation is that in order for the VA to do what the secretary appears to want to them to do, they're going to need a significant amount of capital investment in this fiscal year and next," said Weidemann. "But this is not an easy time to get capital investment of any magnitude through congressional appropriations for non-Defense agencies."

    That said, "VA probably has a better shot at that than most others," he added. "But I would be surprised if the department gets what they're asking for in full. That hasn't been the trend for the past few years – and that was with an Obama administration that was slightly more expansive view of what non-Defense discretionary expenditures should look like."

    With so much downward pressure on budgets right now, said Weidemann, "my guess would be that you'll maybe see a slight downscaling of expectations, either on time frame or in terms of how expansive this migration or rip-and-replace ends up being. Because I doubt that the VA gets the full amount that they're asking for."

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

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    Carequality, a nationwide interoperability framework that makes possible the exchange of healthcare data between and among networks, reports that more than 1,000 hospitals, 25,000 clinics, and 580,000 healthcare providers are connected.

    The numbers represent more than 50 percent of all healthcare providers in the country.

    [Also: Cerner, Epic shops begin electronic exchange of patient records]

    Mariann Yeager, president of The Sequoia Project, which is the parent of Carequality, revealed the numbers during The Sequoia Project’s Annual Meeting, which is taking place this week.

    “When we first kicked off planning efforts for Carequality in 2014, we knew it was going to be big,” Yeager said in a statement. “We had many of the biggest names in healthcare – including healthcare providers, technology vendors, pharmacies and others – committing to making Carequality work and implementing the framework.”

    [Also: Tiger Institute joins Sequoia Project, linking EHRs with SSM Health]

    According to Sequoia numbers, in October 2017 alone, more than 1.7 million documents were shared among healthcare organizations through the Carequality Interoperability Framework.

    The rate of exchange is accelerating each month. Two million documents were exchanged for the first 12 months, and nearly as many are exchanged now monthly, Yeager noted, adding that she expects growth to continue over the next year as existing implementers continue to onboard clients, and more than a half dozen implementers are expected to go live in the first quarter of 2018.

    [Also: CareQuality, Commonwell to collaborate on health data exchange, interoperability]

    The CommonWell Health Alliance, founded by six EHR companies, and Carequality are collaborating. To understand the collaboration, it helps to think of CommonWell as a network – much like a telephone service provider, and to think of CareQuality as providing the framework – the rules of the road. Both are critical for data sharing.

    “Carequality’s success stems from the core principles of inclusivity and openness we laid out during early planning meetings,” Dave Cassel, vice president of Carequality, said in a statement. “We brought together competing vendors, providers large and small, HIEs, government agencies, pharmacies, and other types of healthcare organizations, allowing everyone to be heard.”

    Cassel credits Carequality’s success to date to open conversation and debate, transparency and openness in all processes.

    “Stay tuned, because the document exchange and participation numbers are going to get a lot bigger,” he added. “Carequality was born out of industry demand, shaped by industry and government collaboration – and now it is succeeding through industry support and participation.”

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

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    Eight more hospitals in for-profit Steward Health Care System will roll out the new web-based electronic health record system from Meditech.

    Steward, which operates some three dozen community hospitals across ten states, is a longtime Meditech client. It say eight additional hospitals in Massachusetts, Pennsylvania, Ohio, and Florida will implement Meditech's Web-based Enterprise Health Record 2018.

    [Also: Meditech rolls out cloud-based EHR subscription model for critical access hospitals]

    Julie Berry, Steward Health Care System's CIO, said the expansion of MEDITECH's new Web EHR is meant to further enhance quality and safety while offering a cost-effective system for organizations working to deliver value-based care.

    "Steward is committed to providing world-class care in a more coordinated, efficient manner in the communities where our patients live," said Berry in a statement. "Expanding our Meditech EHR throughout the organization was a key component in moving us toward a more integrated healthcare delivery.

    Steward deploys legacy platforms from Westwood, Massachusetts-based Meditech, but Berry said the health system was intrigued by the innovative structure of the new web-based platform.

    "It's exciting to be deploying solutions built for the web to aid in improving quality and population health, while continuing to drive costs down," she added. "Leveraging Meditech's innovative Web EHR to help navigate an ever-changing climate was a vital part of our decision to move forward with Meditech."

    The cloud-based platform aims to offer smaller hospitals robust functionality at a sustainable price, said Meditech Executive Vice President Helen Waters.

    "Meditech values our long-term relationship with Steward Health Care and we're pleased to have them continue to transform care across North America in the ambulatory and acute environment with Meditech's modern web solution," said Waters.

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

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    The health system already uses Meditech's legacy platforms at many of its three-dozen inpatient sites, but is also rolling out the new cloud-based platform at community hospitals in four states.

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    The health IT sector should look to drug and device industries as examples to establish a successful ecosystem of innovation.

    When it comes to health information technology, innovative ideas and companies abound. Downstream improvements in outcomes or costs of care resulting from these innovations, however, have to date been underwhelming.

    To illustrate this observation, there is no better example than the limited results yielded by the massive investment in electronic health records (EHRs). Another can be found in the $28.7 billion consumer wearable technology market. A recent randomized controlled clinical trial found that individuals using wearables lost less weight over 24 months than those making lifestyle changes alone.

    This finding is disappointing, but unfortunately not unusual — despite generating such excitement and investments in these innovations, less-than-optimal or even negative outcomes make it clear that we have yet to fully ascertain HIT’s potential.

    Some may attribute this underperformance to the general complexities and attributes of the healthcare sector, but we, as members of the Network of Digital Evidence (NODE), disagree. One need only to look to the drug and device industries to see examples of far more mature and effective, albeit imperfect, processes that have served as guides for countless innovations from development through to scaling and implementation.

    An unwieldy HIT ecosystem (or innovation pipeline), especially related to digital medicine, has developed, one in which innovators create products and then scramble to navigate the complex and opaque needs and buying processes of health systems.

    The end consumers may not be familiar with a particular innovation, but they can be assured that the drug or device in question has passed a rigorous FDA-led evaluation. There are no such guidelines or evaluations to serve/for the HIT innovation community.

    Medical institutions, meanwhile, struggle to sort through the vaporware and correctly identify the legitimate and promising innovations in digital medicine.

    Despite major investments in HIT, drug and device development appear to dramatically outpace that of HIT innovation — why? This may ultimately be due to the maturity of the innovation pipeline across those three segments of the healthcare system. The drug and device pipeline is far more standardized, academic, and regulated than that for HIT, and it is this level of sophistication that enables a consistent production of novel drugs and devices.

    It is clear that HIT must develop a comparably evolved pipeline; only then will this sector stand a chance of enjoying a steady, reliable stream of implementable innovation.

    Neil Carpenter is Vice President of Strategy, Research and Transformation – LifeBridge Health and wrote this article on behalf of NODE Health. a consortium of 25-plus health systems to support Evidence-based Digital Medicine.

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

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

    Updated Oct. 12, 2017

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    Henry Ford Health
    Slideshow Description: 

    Henry Ford Health System is notifying patients that a hacker breached its system in early October and potentially viewed and stole the data of 18,470 patients.

    Read the full article

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    Arkansas Oral Facial Surgery Center
    Slideshow Description: 

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

    Read the full article

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

    Read the full article.

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

    Read the full article.

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

    Read the full article.

     

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

    Read the full article.

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

    Read the full article.

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    St. Mark’s Surgery Center
    Slideshow Description: 

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

    Read the full article.

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

    Read the full article

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    Plastic Surgery Associates of South Dakota
    Slideshow Description: 

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

    Read the full article

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    Anthem BlueCross BlueShield
    Slideshow Description: 

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

    Read the full article

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    Women’s Health Care Group of Pennsylvania
    Slideshow Description: 

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

    Read the full article.

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    Peachtree Neurological Clinic
    Slideshow Description: 

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

    Read the full article

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    UC Davis Health
    Slideshow Description: 

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

    Read the full article.

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

    Read the full article.

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    Bupa global health insurance
    Slideshow Description: 

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

    Read the full article.

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

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

    Read the full article

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    Cleveland Medical Associates
    Slideshow Description: 

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

    Read the full article

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    Airway Oxygen
    Slideshow Description: 

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

    Read the full article

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

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

    Read the full article

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    Washington State University
    Slideshow Description: 

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

    Read the full article

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    Torrance Memorial Medical Center
    Slideshow Description: 

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

    Read the full article

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    Molina Healthcare
    Slideshow Description: 

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

    Read the full article.

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    National Health Service in England and Scotland
    Slideshow Description: 

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

    Read the full article

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    New Jersey Diamond Institute
    Slideshow Description: 

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

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

    Read the full article

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    Harrisburg Gastroenterology
    Slideshow Description: 

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

    Read the full article

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

    Read the full article

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

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

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

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    HealthNow Networks
    Slideshow Description: 

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

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    ABCD Children's Pediatrics
    Slideshow Description: 

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

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    Washington University School of Medicine
    Slideshow Description: 

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

    Read the full article.

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    Metropolitan Urology Group
    Slideshow Description: 

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

    Read the full article.

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    Denton Heart Group
    Slideshow Description: 

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

    Read the full article.

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    Brand New Day
    Slideshow Description: 

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

    Read the full article.

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    Singh and Arora Oncology Hematology
    Slideshow Description: 

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

    Read the full article.

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    Verity Medical Foundation-San Jose Medical Group
    Slideshow Description: 

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

    Read the full article.

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    CoPilot Provider Support Services
    Slideshow Description: 

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

    Read the full article.

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    Indiana-based Cancer Services
    Slideshow Description: 

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

    Read the full article.

    Teaser: 

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

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

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    Despite the fact that the law has been on the books for more than two decades, there's still a lot of misconceptions about HIPAA and the ways it applies to information sharing. We've even heard horror stories about hospitals refusing to furnish patients with their own data, saying that doing so would be a HIPAA violation.

    A new report from de Beaumont Foundation and Johns Hopkins Bloomberg School of Public Health aims to demystify some of the lingering questions about HIPAA protections, and in so doing help break down some of the potential barriers to more widespread electronic health data exchange for public health.

    The study, "Using Electronic Health Data for Community Health," is meant as a roadmap of sorts for overcoming those perceived legal impediments.

    [Also: Is HIPAA outdated? AHIMA questions whether law is keeping pace with change]

    Thanks to the now-widespread adoption of electronic health records, easy access to digital patient data "offers an opportunity for a leap forward in data access to address community health challenges," according to the report. For example, "a recent survey of 45 senior public health officials found particular interest in using electronic health data to both guide action and geographic 'hot spotting' of both communicable and chronic diseases not included in statutory reporting requirements."

    But too often, HIPAA has seen an impediment to information sharing between health systems and public health departments, the authors say. In the report, they highlight the legal underpinnings for data sharing and offer a series of constructive uses where an exchange of patient data improves population health.  

    "HIPAA, and its implementing regulations recognize the legitimate need for public health agencies to gain access to private health information to carry out public health activities," the report authors write. "To do so responsibly and successfully under the law, public health agencies must be clear about their goals, specific in their requests, and take steps to assure the confidentiality of key data."

    By presenting a series of use cases – focused on disease surveillance, direct messages to providers, quality improvement initiatives and more – the report spotlights permissible voluntary disclosures under HIPAA, explaining what health systems can share with public health agencies under the law. 

    It also offers a lengthy FAQ section, with questions ranging from the basic (What is HIPAA? What is the HIPAA Privacy Rule? What is Protected Health Information?) to the advanced (What should covered entities do to comply with the minimum necessary standard? What is best practice for releasing data that includes geocodes?).

    In addition, the report offers a series of recommendations for public health departments for more HIPAA-compliant access to electronic health data:

    1. Define key public health issues and goals with broad community support."Public health agencies can start by defining critical issues and building consensus around the need to address them," according to the report. "A discussion on data sharing can then be set in the context of public interest in addressing childhood asthma, the opioid epidemic, or other important challenges. (It is rarely persuasive to ask anyone to share data for the sake of sharing data.)"

    2. Develop a data request with a clear explanation, plan for privacy protection, and plan for data use."As the use cases demonstrate, the specificity of a request makes it possible for others to consider the value and cost of participation. It may be helpful to engage with key sources of data as the request is developed to be sure that what is requested is feasible."

    3. Obtain legal review to assure key participants of compliance with HIPAA and other applicable state and local laws."A legal review can provide assurance that plans are compatible with key standards in HIPAA and other applicable state laws. It is hoped that this paper can serve as a starting point for this review."

    4. Provide for public engagement for the purposes, use, and protection of data."Public engagement provides an important measure of transparency about plans for data sharing and public health action. Public health agencies can create and implement an engagement strategy that strengthens support for actions to improve health outcomes."

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

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    It's been a big year for Allscripts. And not just because of the $185 million acquisition of McKesson Enterprise Information Solutions that closed in October. 

    On the interoperability front, the company hit a milestone this year too: a whopping one billion API data exchange transactions in 2017, touted as the most-ever in a calendar year. 

    Now, with much of the hard work of meaningful use in the rearview mirror, Allscripts CEO Paul Black says the time has come to have some fun with innovation. Healthcare IT News spoke with Black about that data exchange milestone, his to-do list for the year ahead and how the company plans to continue serving its clients, new and old, having grown into one of the largest health IT companies in the world.

    Q. You've got a much larger footprint across the U.S. now. What are some of the things you hope to accomplish following the McKesson deal, strategically, in the near future? 

    A. It is early yet, we just closed on October 2, but the response thus far has been very positive. We'll end 2017, going into 2018, with Cerner and Epic, having created a real separation of the pack. There will be three large organizations, if you will, at the top of the heap. And then you go from $2 billion plus, down to about a billion with our friends at athenahealth, and then the rest of the group, at $500 or $600 million and below, there's a group of eight or nine of those in the EMR business.

    So there's a clear separation that's gone on and we find ourselves in the position we've been coveting for a long time. And we’ve done it both organically and now a bit inorganically. We've done it through investments in R&D, and we've done it through investments in assets we think give us the scale and impact we're trying to create in the marketplace.

    It gives us marketshare in the inpatient space and we're very proud of that. And it also gives us a low-end solution in Paragon that will create a clear distinction in our marketspace, just as others have done, by taking the solution they have and minimizing its functionality in some cases and in other cases by creating a service orientation to the offering, to create a distinct offering for community hospitals – and there's still a lot of opportunity there.

    And then lastly the cross-sell opportunities that we have by taking our population health solutions into that McKesson space. As well as some of the solutions that McKesson has that will go into the Sunrise space – around OneContent, lab and some of the other solutions that they have. So, we're all in. We're pleased. So far, so good. There's a lot of very positive momentum coming out of that.

    Q. As you cast a wider net, what are the biggest imperatives you're trying to help hospitals and other clients solve?

    A. We made a pivot to play more offense than defence the first couple years I was here. We had to tank the P&L to make some investments in R&D to make sure we took care of some of our client obligations on the meaningful use side, and just doing what we had to do there. We were very proud of our ONC certification, very proud of getting our clients to attest for those important milestones.

    But amid that, we also got back to our entrepreneurial roots inside the company where we have, in some cases, a couple in-house startups where we actually have the CEO of this and the CEO of that and a separate and distinct organization that is built around an entrepreneurial idea. We continue to innovate on top of the platforms we have and continue to spend money on the R&D side.

    On a go-forward basis, the thing I said in 2012 is still true: Being a really great EMR company isn't going to be enough. You have to have – and we have continued to evolve – a population health platform, a post-acute care platform, a consumer platform and, what we've been working on for the past 24 months, a precision medicine platform. 

    In the marketplace, those are all resonating quite well, and I think that vision of not only being important transaction machine, if you will, at the EMR level, and all the attendant accountability and obligations you have as a result of being the system that people use and interact with every day, that's not enough.

    Q. You mentioned meaningful use, and while it continues to be a going concern, it's not quite hovering over everything to the extent it was five or so years ago. Now it seems like there's space is to really start innovating to tackle an array of real-world challenges –  for lack of a better term, to have some fun. Does it feel that way to you?

    A. I think that's a great word. I've not heard it described as fun, but I think it is, seriously. Because for the first time in the history of the universe, this platform is all digital. There's been yeoman's work to do it; we can just dust our shoulders off and say, ‘That was hard.’ But now it is time to have fun. To understand all the data coming out of these systems that for the first time are automated. To make sense of it – operationally, clinically, quality wise – and to do things that you would not historically be able to do because you lacked information.

    How do you repurpose networks for quality? How do you repurpose relationships for financial synergies, how do you connect with consumers and enable them self-schedule and do a bunch of the work that the airlines have been doing for a long period of time, in order to create a more efficient and effective exchange not only of clinical information but of access to healthcare in the appropriate venue with a consumer who's going to be demanding that?

    We're training a whole generation of humans to consume things and interact with services differently. And healthcare is going – I think – to get turned upside down over the next five years because of the power that the consumer has at their fingertips and the demands they will make on an industry that is in some cases ready for it, and some of our clients have been thinking about it this way, but the organizations who get there soonest will have the most market share in the communities they serve. And I think that will be a lot of fun.

    Q. For all the fun, however, there are still some pretty big challenges out there. Interoperability, for instance. How are we doing there, from your point of view, and how does Allscripts plan to move the needle on data exchange in 2018?

    A. We just passed the billion mark for data shares for the first time in a single year. We've been monitoring how many API calls have been made at that level inside our ecosystem, and thus far this year we've had a billion. We don't know of anyone else in the industry who has hit that level of interoperability, or has created an ecosystem that allows that number of shares to occur.

    We think that's a really big deal. The number of registered developers is now 6,600. There have been 1,580 client activations by third-party API solutions – that's a lot. We're at 111 million API data shares just in the month of October, and 2.95 billion data shares since 2013 when we first started counting it.

    We've been talking about open connected communities of health, open systems, for 10 years. And I think it's very important to say we've had a billion transactions: Real information is being exchanged and people are getting value out of it, otherwise they wouldn't be doing it.

    Part two of our Q&A with Paul Black will run on Healthcare IT News on Friday.

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    Looking for a fresh perspective on electronic health record usability and optimization? Here it comes.

    “Hospitals can make any EMR work if they put the right governance, customization and education in place,” said Mike Davis, who research firm KLAS on Thursday signed up as Lead Analyst for its Arch Collaborative.

    Davis, a co-creator of HIMSS Analytics EMR Adoption Model known as EMRAM, said KLAS facilitates the Arch Collaborative to pinpoint real-world issues regarding physician workflow, practices and inefficiencies.

    “We need to capture more and better data to modify healthcare practices to deliver care more efficiently,” Davis said. “The only we’re going to improve that is through data.” 

    KLAS outlines those three keys to success in a new report, Creating the EMR Advantage.

    The educational aspects include initial and ongoing training, beginning with having clinicians spend 6 or more hours in classes and they really should be led by other clinicians, rather than online or even live specialists who know the software well but might not understand how doctors actually work.

    Whether called personalization or software customization, this aspect is important because well-optimized EHRs are not one-size-fits-all. Oncologists, for instance, do not work the same way as emergency department doctors do. Davis added that it’s not uncommon for hospitals to inhibit any kind of personalization because it makes supporting the software program more difficult.

    And then there’s culture. One of the more significant lessons Davis said the Collaborative has learned in conducting research with 19,000 responses is that culture has a bigger impact on EMR success than the actual EMR itself. “Organizations that succeed have cultures that want to ensure they’re doing what they can to optimize EHR use,” Davis said.   

    The Arch Collaborative aims to help participating members gain that level of understanding. The Arch Collaborative, which includes some 55 participants, notably Allina Health, John Muir Health, Kaiser Permanente, Mayo Clinic, UC San Diego, and Tufts Medical Center, among others, began in 2016.

    Davis explained how it all works. Any big clinic, hospital or EHR vendor is invited to participate. In the first step, KLAS will conduct an initial survey free-of-charge.

    That essentially helps providers reach a certain level of participation. Then once the survey closes, the ARCH Collaborative goes through and analyzes the data to look at physician satisfaction, governance, training.

    From there, they create a PowerPoint (they usually include about 115 slides), suggesting minor modifications to the 3 keys to success in education, personalization/software customization and culture.

    Hospitals that choose to join the Arch Collaborative, in turn, receive a formal report. Davis said that so far more than 70 organizations are in this process, while about 30 have completed it gotten the formalized report. 

    Davis added that the research the collaborative is undertaking will help it draw out best practices for optimizing and using EHRs to deliver on their promise and meet the needs of clinicians. And with organization in the United Kingdom and Australia also participating, he said they are aiming for a global view.

    “We’re doing a deep dive so people understand where they have opportunities for improvement to get to a point where clinician satisfaction is higher,” Davis said. “It’s the Pareto rule. If we get to point where 80 percent are happy we’ll be in good shape.” 

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

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    In part one of our two-part Q&A with Allscripts CEO Paul Black on Thursday, he explained how the acquisition this year of McKesson’s health IT business has vastly increased the company's scale nationwide, and how he plans to capitalize on that to position the company for a new era in healthcare – focusing on innovation on an array of fronts and having some "fun" helping its clients solve an array of challenges.

    In part two, Black looks toward 2018 and beyond, discussing how Allscripts aims to continue making inroads with precision medicine, artificial intelligence and more.

    [Also: Allscripts CEO Paul Black claims the EHR vendor will pull ahead of the pack in 2018]

    Q. Let's talk about precision medicine. I spoke at length recently with Joel Diamond, MD, CEO of Allscripts subsidiary 2bPrecise, about the near-term future for genomics and personalized treatment. Where do you see things heading here? How far off are we from it becoming the standard of care? What will providers and vendors alike need to start doing differently?

    A. I think it is here today, but not necessarily at volume. But the fact that there are some 50,000 orderable procedures that you can order through LabCorp or other lab houses, the fact that those genetic tests are out there – not necessarily for a full genetic sequence, but also could include a two-panel test for a very specific condition you might have. To the extent that those are already out there, I would say it's already mainstream today.

    But to the question of when it will be best community practice, I think that will be specialty type by specialty type. Clearly ASCO is pushing that for oncology and there's a lot of efficacy for getting genotyped for breast cancer and for other types of cancer. So the importance of getting the chemotherapy right based on the way your body is going to metabolize it is extraordinarily important, because you want to make sure you're on the right regimen. Different specialties will bring this to the forefront at different rates. But there is so much being published about it, so many studies being run, so many countries doing serious work based on certain segments of the population to understand why they are sick and how to best treat that in genomic sequencing in some form or another – that's all playing a very major role today.

    I think 2bPrecise is very well positioned in that it's EMR agnostic, in that it surveils the database to actually look for people who should be sequenced, based on family medical history, based on current diagnosis, based on current medication regimen. It will actually say, This person might benefit from, and other people like them have benefited from, a genomic test. That then leads to the question of will insurance companies, will CMS become players in this. And I think the answer to that is yes and in many cases they already have. On the macroeconomics, the health economists will say these tests will pay for themselves, because of the efficacy, because you minimize the delay, minimize the effect of having people on the wrong medication, so you have the same or smaller spend.

    [Also: Rx precision medicine tool latest to be integrated into clinical workflow]

    So I think the combination of consumers demanding it, of insurance companies understanding the economics, the reality of the price performance – that the tests are no longer $10,000 to have a genome sequenced, the Moore's Law effect, if you will. All of that comes together to say the time is really great for this to be not only best community practice but also standard operating practice clinically in the next three to five years.

    Q. What are some of the technology innovations you're particularly excited about? How do machine learning and AI factor into your plans, for instance?

    A. We have talked about a new EMR that would be AI-based, machine learning based. That is something we have been working on. And that solution is predicated on the machine doing a lot more work for the physician with regard to how you practice, practice patterns, condition of payment, the medical history you have on a person and what sort of questions should be asked the patient is in the room – what kind of things have you asked of this patient that you either have or have not yet documented.

    And so that component of a true assistant – something that truly adds value to the experience for the physician as well as the patient, is work that has been underway for the past three-plus years inside the company. We also have a substantial amount of data that we collect and have in a database of some 40 million different lives. That we have, in a deidentified way, a set of capabilities to look for patterns in that data that we might historically not have seen without the advent of an AI data crawler or capabilities where the data are being correlated in different ways that a PhD scientist may not have had a thesis around, historically.

    So you're not as reliant on the smartest guy in the room to look at data as you are on the machine to bring you revelations based on correlations that exist in the data that you were not aware of. And, importantly, make that actionable because you have an EMR capability that will allow that to occur. So it's another extraordinarily exciting set of capabilities that exist today that weren't here a decade ago. And it's absolutely another top performer, from my perspective, in the 'fun' category.

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

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    Ever since hospitals started implementing electronic health record software, certain concerns have lingered in hospital executives’ minds about accountability, liability, even the threat of medical malpractice. And startling legal events of 2017 did not alleviate those fears.

    On the last day of May, eClinicalWorks settled a landmark $155 million False Claims Act suit with the United States Department of Justice that invariably raised questions: Is it the only EHR vendor to, knowingly or not, certify software for meaningful use criteria despite deficiencies that could be a risk to patient safety? Will the DOJ investigate rival EHR makers for similar reasons? Is a class-action lawsuit coming, too?

    That last query answered itself when in mid-November eClinicalWorks was hit with a class action case exactly one dollar short of $1 billion. The suit, filed by the estate of patient Stjepan Tot, alleges breach of fiduciary duty and gross negligence because the software failed to accurately display his medical records and, as such, blocked him from determining when his cancer symptoms first appeared.

    EHR vendor Epic Systems, too, was greeted with a False Claims suit in early November. That case alleges Epic’s billing software has a glitch that double bills the government for anesthesia services and, as such, caused hundreds of millions in overpayments.  

    Then in late November the law firm Anderson, Agostino & Keller filed suit against CIOX Health and 62 Indiana hospitals for falsifying records in an overbilling and kickback scheme to the tune of $300 million.

    When taken together, those incidents have left many hospital executives and IT professionals wondering exactly what their responsibility might be in all this. Not to mention what they can do to protect themselves.

    Take a deep breath because it’s time to pull out that EHR contract and take a look inside. No time like right now.

    EHR contracts: What to look for

    Whereas hospitals and other customers can really only do so much in terms peeling back the curtain concealing EHRs code, there are steps anyone can, and indeed should, take when either switching to a new EHR vendor or renegotiating existing contracts.

    “What you always should be doing is looking at documentation, relying on common sense and medical judgment, and if they see something that doesn’t look right, question everything,” said Erin Whaley, a partner with Troutman Sanders, a law firm in Richmond, Virginia.

    [Also: Solving cloud computing's CapEx vs. OpEx conundrum once and for all]

    Whaley added that good contracts will ensure that customers have indemnification, recourse against the vendor in the event that something goes wrong, limitation of liability clauses that prohibit the vendor from capping what it pays and essentially leaving a hospital on the hook. 

    As a healthcare attorney, Whaley said contracts run the gamut from large health systems that likely negotiated solid contracts to small and critical access hospitals lacking in-house legal expertise and mid-size hospitals that may not have had the savvy to negotiate as well for themselves.

    “Different vendors have different contracting standards, some are able to limit their liability for any type of breach. That’s something providers should be looking at,” Whaley explained. “Negotiating renewals or a new contract presents an opportunity to get more favorable terms.”

    What not to miss in EHR contracts

    For Corinne Smith, a partner with Strasburger & Price, a Texas law firm, it’s easy for healthcare organizations to miss crucial elements as there’s a lot to consider -- especially in the IT realm where it’s difficult for people to know exactly what to expect from a vendor.

    So to start, an organization will need to determine the right contract based on whether the EHR platform is in a cloud or on the provider’s network. Smith explained that if the EHR runs on the organization’s own server, there doesn’t have to be the same level of service agreements, as the provider is responsible for their own service.

    But if the platform is cloud-based, Smith said there will need to be a separate contract for that element. 

    Hospitals often fail to pay enough attention to the terms involving the system after it’s installed. Providers will need to get into their own system for claims disputes, revenue cycle and even potential litigation.

    “There needs to be a plan in place for the date past installation,” said Smith, especially concerning how the data is converted into the old system and if and where it will be stored. “Usually that’s another charge.”

    Another crucial element to examine is terms and conditions -- this should be of special concern to providers that don't necessarily make quick payments. Smith explained that providers should look into interest terms and can even demand there be a dispute resolution process included, with both timing and renewal.

    “All of these things should be put into the price,” Smith said. Providers should also look for hidden costs, like additional charges for interface, training and the like. “A lot of those are sort of buried.”

    The biggest mistake an organization can make is “paying too much money up front before a product is fully tested and put into production, then holding money in reserve for after testing and go-live,” Smith added.

    “I’ve seen contracts where they have to pay for the whole platform before testing was complete,” said Smith. “If they pay in full upfront, there’s just not the same level of urgency. You have to hold a substantial amount of money of the contract to make it worthwhile for the vendor.”

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

    And the service agreement should not start until after the EHR goes live, after the tests and modules are put into place.

    Smith encourages her clients to use a unique method to make sure they’re in control of what goes into the EHR contract and that all of their needs are met.

    “The best thing to do -- to be the most proactive and get the most from the contract -- put out an RFP of your terms and conditions,” said Smith. “Before you get a contract from Meditech, Cerner or others, let the vendors know you’re not going to have a contract unless they meet your outlined terms.”

    These elements can include ONC requirements and pricing, among others, and will ensure that your contract is built on your terms and needs, Smith explained. “It’s just so difficult because each of these companies have their own contracts, and they don’t like to deviate.”

    Don’t forget ONC’s certification site

    Providers should refer to the Office of the National Coordinator for Health IT’s website that lists vendor requirements, regulations and certifications. Smith explained it outlines necessary elements for contracting with an EHR vendor, which can prevent missing technological functions.

    Despite these recent False Claims suits hospitals still need a product that has been certified to attest to meaningful use and earn reimbursement incentives. 

    “For the most part EHR certification criteria today does, in fact, ensure that hospitals are buying attestation-capable EHRs,” said Blain Newton, Executive Vice President of HIMSS Analytics. 

    Newton added that since the inception of meaningful use, the Centers for Medicare and Medicaid Services has paid some $37 billion to more than 537,000 providers, based on CMS data posted in September of 2017.
    Smith said that organizations should require vendors to include representation warranties in the contract, stating that they meet ONC requirements.

    “In the contract, there should be requirements that when new regulations come out, the vendor must make the best effort to comply with those regulations moving forward. It should also include all the things they need to do to meet those standards,” Smith said. “And you can be sure the vendors aren’t too happy with that because it’s more work for them.” 

    Plaintiffs prefer deep pockets

    Troutman Sanders attorney Whaley said that plaintiffs thus far have been looking for big payouts.

    “Right now some of the deepest pockets out there are the EHR vendors,” Whaley added. “So if plaintiffs can find a claim against EHR vendors they see bigger recovery than against hospitals or physicians for malpractice.”

    But it cannot be ignored that as the suit involving CIOX Health and 62 Indiana hospitals showed that hospitals, too, can face lawsuits over their use of EHRs and the Epic and eClinicalWorks demonstrate that the EHR certification process for attesting to meaningful use and earning reimbursement incentives, the evidence suggests certification works. 

    And that means dusting off that EHR contract should be on the list of hospital executives New Year’s resolutions, 2018 edition. 

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

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    New Year’s resolution: Dust off that EHR contract to make sure you’re as protected as you think
    Newsletter teaser: 
    With lawsuits against eClinicalWorks, Epic and 62 hospitals over EHR use, are you certain your contract is solid enough to protect your org? Time to take another look.

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    The U.S. Department of Veterans Affairs spent $1.1 billion with 138 contractors from 2011 to 2016 on multiple efforts to modernize its legacy EHR system, VistA, according to a new report from the Government Accountability Office.

    The spending poses some serious questions about how the VA manages its IT practices, GAO Director of Management Issues David Powner told the House Committee on Oversight and Government Reform on Thursday.

    [Also: Cerner DoD overhaul coming out in waves; VA deal means 'single system' approach]

    According to the report, contract data revealed that 15 key contractors tasked with development, project management and operations and maintenance accounted for $741 million of funding obligations.

    “The department has reported progress on consolidating and optimizing its data centers, although this progress has fallen short of targets set by the Office of Management and Budget,” the report found. “VA has also reported $23.61 million in data center-related cost savings, yet does not expect to realize further savings from additional closures.”

    As most of the money was spent on what’s now obsolete software and programs and the VA is drawing closer to sign its EHR contract with Cerner, it highlights the need for the VA to amend its management practices to avoid making the same mistakes, explained Powner.

    [Also: Cerner EHR project for VA will take 7 to 8 years, Shulkin says]

    The report also raises questions as to whether the agency is equipped to handle its EHR modernization project, said subcommittee leaders Will Hurd, R-Texas and Robin Kelly, D-Illinois. Kelly was specifically concerned about the VA hiring, firing and rehiring 34 contracts during the GAO study.

    To Powner, the agency needs to focus more on collaborating with relevant offices, leadership continuity and look to the Department of Defense’s Cerner implementation for guidance.

    "VA is in the midst of a turnaround," said VA Acting CIO Scott Blackburn. Trust was broken in 2014… And while veteran trust in the agency is increasing, “we still have a long way to go.” 

    Twitter: @JessieFDavis
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    While early reports about the planned $77 billion merger between CVS and Aetna focused on massive market share in the pharmacy and insurance realms, there is also the promise of a new era in analytics, interoperability and population health at the heart of the arrangement. 

    CVS is the biggest pharmacy chain in the U.S. by a number of locations and prescription revenue, Aetna is the nation's third-largest insurance company. Epic Systems, which is not a party to the merger but has been a CVS partner since 2015, is the largest electronic health record vendor.

    [Also: Epic, CVS hope analytics partnership will rein in drug prices]

    The sheer size of these players means the deal stands to have a transformative impact on how healthcare is delivered in this country. 

    For starters, data – and lots of it, given that CVS has 9,700 retail locations and more than 1,100 walk-in clinics nationwide – was clearly a huge driver for the deal. 

    Alan Hutchison, Epic's vice president of population health, said that by using Epic’s Care Everywhere and Share Everywhere interoperability tools, CVA and Aetna could provide the rest of the community with information and insights to improve care.

    [Also: CVS to deploy Epic EHR across its chronic care management programs]

    "What's really interesting about working directly with payers, providers, and patients is the ‘gray space’ – the opportunity that exists between traditional sites of care and all of the other organizations that are involved in the patient’s healthcare experience," Hutchison said. 

    CVS signed on with the Verona, Wisconsin-based behemoth for its MinuteClinic locations back in 2015, and earlier this year expanded the partnership, choosing Epic to supply the electronic health record system for the care management programs of its CVS Specialty arm. 

    Then in October, Epic and CVS announced another expansion of the partnership, with the pharmacy using Epic's Healthy Planet pop health analytics platform to learn more about drug dispensing patterns and medication adherence, with an eye toward more cost-effective prescriptions. 

    "I can think of using the CVS retail data as a population health monitoring service, I can think of using the over the counter sales data tied to individuals to fuel predictive models for future opioid issues, or arthritis flares, or pulmonary hospital admissions or one hundred other things,” David Anderson, a research associate at Duke University Margolis Center, wrote in a recent blog post. “So from my former point of view as an insurance data geek, this merger offers an incredibly rich vein of data that can be mined and minted."

    How patients win

    Management of chronic disease – through patient engagement, telehealth and remote monitoring – is a fundamental aim of the CVS-Aetna acquisition. 

    As Aetna CEO Mark Bertolini said when the deal was announced: "I think you have to think of it as keeping people away from the medical-industrial complex by offering better services in the home by meeting social determinants of health, which are big drivers of healthcare expenditures today, much bigger than people understand."

    CVS Health CEO Larry Merlo said the arrangement will enable the combined company to deliver services that many hospitals currently do not.

    “The traditional healthcare system lacks the key elements of convenience and coordination that help to engage consumers in their health,” Merlo said. “That’s what the combination of CVS Health and Aetna will deliver."

    Epic’s Hutchison added that bringing together such otherwise disparate pieces as the ones Bertolini and Merlo mentioned is in the best interest of patients because it can both improve outcomes and reduce costs. 

    "Information is coordinated, friction is reduced, and data is used to predict what might happen to a patient so that steps can be taken through targeted programs to prevent negative outcomes or costly episodes of care," Hutchison said. 

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