The Indian Health Service posted a request for information as part of exploratory market research to assess innovations for modernizing its electronic health record system.

Right now, IHS uses what it calls a self-developed, integrated "government-off-the-shelf health information system-of-systems" known as the Resource and Patient Management System, or RPMS.

[Also: VA to require Cerner prioritize interoperability, secure data exchange in EHR project]

"IHS' objective is an effort to modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure," IHS explained in the RFI. 

Toward that end, IHS is using to better understand the available options related to a number of imperatives, including practice management, clinical decision support, quality measures, interoperability and HIE, population health management, privacy and security and more.

The agency’s current EHR is a "distant cousin," as IHS officials put it – derived from the same legacy system and using many of the same apps – to both the longtime VistA proprietary EHR used by the Department of Veterans Affairs and the Composite Health Care System used by the Defense Health Administration.

Now would seem to be a logical time to consider alternatives to the RPMS – which is in operation at IHS Federal, Tribal and Urban hospitals and health centers across 36 states, where IHS delivers care for some 2.2 million American Indians and Alaska Natives – given that RPMS' cousins at VA and DoD are in the process of being replaced by Cerner technology.

The demands of interoperability, the need for the IHS technology to interact with other commercial-off-the-shelf EHRs, is a challenge – one that's "enhanced given diversity and individuality of the instances, as well as rising operations and maintenance costs that result from ‘one-off' instantiations and lack of standardized configuration management," according to IHS. "Over time, the architecture and complexity of IHS health IT systems, as well as their criticality to healthcare operations, have become one of the many catalysts for IHS to re-evaluate its current approach to software development and deliverance of health IT services.”

IHS says its "multiple legacy systems and disparate data stores, developed over four-plus decades, are in need of modernization to ensure and enable sustainability, flexibility, intra/interoperability, patient data federation, population health, and clinical quality measures, toward improved continuity of care."

At the same time, given the many shapes and sizes of IHS facilities, with varying degrees of connectivity/bandwidth, officials said a one-size-fits-all commercial-off-the-shelf EHR approach is unlikely to work from the standpoints of both functionally and economic feasibility. 

So its request for information aims to learn more about "art-of-the-possible" practical COTS technologies that, alone or in combination, can help address IHS' 21st Century needs.

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

Vermont’s health information exchange has big financial and administrative problems, and a recent review by Kentucky-based technology consulting firm HealthTech Solutions concluded that most exchange users had lost confidence in the organization.

The HIE, which is is operated by Vermont Information Technology Leaders (VTIL), has received $44.3 million in state and federal funding since its launch in 2005. 

The concerning review comes at a time when many state HIEs are trying to determine the best way toward financial sustainability because they are going to become critical to the Office of the National Coordinator for Health IT’s charge to implement the 21st Century Cures Act. 

[Also: What's next for health information exchanges?]

Vermont HIE’s administrators are not ready to give up and, instead, said they are developing a multi-year plan to bolster the exchange. HealthTech survey results, in fact, showed stakeholders consider it critical for Vermont to continue operating the entity.

But there are challenges ahead. The survey also revealed the HIE’s current structure and governance is not meeting stakeholder and state needs. In response to a survey question, only 9 percent of respondents agreed the state has provided guidance and planning for the HIE. 

Other responses said stakeholders believed the exchange could be fixed with better technology and improved governance and organizational structure. The HIE, which is is operated by Vermont Information Technology Leaders (VTIL), has received $44.3 million in state and federal funding since its launch in 2005.

The exchange is critical for Vermonters who rely on the HIE to provide data for Accountable Care Organizations as well as for policymakers to measure effectiveness and impact on costs.

There are models for operating successful state-run HIEs. Colorado, Delaware, Maine, Maryland, Michigan, Nebraska, Oklahoma, Oregon and Utah are oft-lauded success stories.  

For its assessment of the Vermont HIE, HealthTech Solutions conducted interviews with 89 Vermont stakeholders, 60 individuals, eight focus groups and a technical expert panel, among stakeholders.

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

U.S. providers have a lot to do with their clinical data nowadays, whether its tracking vitals to stave off healthcare-associated infections, applying predictive analytics to prevent hospital readmissions or tracking any number of myriad quality measures for value-based care.

They need intelligence tools to do that, of course, and more and more health systems are upping their investments in the technology they need to manage in the world of accountable care. And not just American providers – the global market for clinical intelligence software is set to grow 12.5 percent between now and 2023, according to a new report from Market Research Future.

[Also: Why more tech vendors are targeting ACOs with analytics, care management tools]

That growth comes thanks, in part, to the big uptick in in the adoption of electronic health records and other IT worldwide, more software-dependent claims processing and the imperative – everywhere – to deliver better care at lower cost.

While the market for clinical intelligence is "expected to grow at an exponential rate," according to the report, which forecasts purchasing in the Americas, Europe, Asia Pacific and the Middle East & Africa, the "high cost of clinical intelligence software solutions may restrain the market growth in developing countries."

Perhaps unsurprisingly, "America is the largest market for clinical intelligence owing to an increasing extensive use of software solutions for healthcare administration and available resources," the researchers wrote. "North America accounts for the largest market share owing to the presence of major healthcare IT companies enjoying global presence."

Europe, meanwhile, is the second largest market for clinical intelligence, and is expected to see "steady growth in the near future due rising number of healthcare providers using clinical management softwares and technological advancement in healthcare IT especially EHR and patient engagement platforms."

But it's in Asia Pacific countries where the analytics market is expected grow at the fastest rate, according to Market Research Future, thanks to "factors such as rising demand for healthcare IT, increasing healthcare expenditure and rising number of healthcare software solution providers. Furthermore, increasing burden of diseases and increasing demand for patient records management also boost the market growth during the review period."

Researchers say they expect parts of Middle East & Africa to "also show a steady rise in the market owing to low demand for healthcare IT, especially in Africa owing to low healthcare expenditure and need for primary care services."

The firm studied various markets with an eye toward retrospective performance measures and predictive analytics, performance measurement systems, clinical decision support systems, quality improvement and clinical benchmarking tools, population health management platforms and more.

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

Informatics, data analytics, privacy and security, clinical documentation improvement and information governance are among the imperatives that will dominate data trends in 2018, according to the American Health Information Management Association.

Data Analytics

Demand for services and projects will increase in 2018, AHIMA predicts. Data analysts are expected to be busy helping providers participate in new payment models and find their way through new policy initiatives such as MACRA.

Informatics

Data experts will help to mitigate physician burnout with electronic health records by streamlining processes to capture data in EHRs, protect patient-generated data in mobile apps and develop interfaces and dashboards for telehealth services, AHIMA said.

Privacy & Security

While cybersecurity incidents will likely continue to make headlines in 2018, there are a number of policies related to data security to watch for this year, AHIMA said. These include the issuing of "minimum necessary" requirements, guidance around mental health information and data sharing as required by proposed rules of both the 21st Century Cures Act and the penalty sharing provision of the HITECH Act, experts said.

Clinical Documentation

Clinical documentation improvement specialists will also continue to be deeply involved with claims denials in 2018, helping to identify denials for coding and documentation that should be appealed as well as continue to expand to new and specialty areas of healthcare such as long-term care, home health, psychiatric units and rehab facilities that call for high-quality documentation, AHIMA predicted.

Information Governance

In the area of information governance, experts said enterprise-wide retention policies and data quality will continue to cause cybersecurity challenges for providers in 2018, demonstrating the strong need for IG programs to address them.

Government & Policy

Federal rules and regulations will also be worth paying close attention to this year. In addition to the 2018 budget, which will affect funding of the Office of the National Coordinator for Health IT and HHS' Office for Civil Rights, the forthcoming definition of "information blocking" defined by the 21st Century Cures Act will be a major story to look for because of its impact on a large portion of EHR users, AHIMA said.

Four big issues impacting inpatient and outpatient coding in 2018 will be reimbursement, telemedicine, copy/paste and coding auditing, the experts added. Also, starting in January, the Medicare Access and CHIP Reauthorization Act of 2015 will require physicians to start reporting patient relationship modifiers.

Workforce

Finally, with regard to education and workforce issues, "upskilling" existing practitioners for more advanced roles in data analytics and informatics, preparing academic faculty to teach higher-level content in data analytics and revising curriculums to ensure students are prepared to meet workplace needs are all education and workplace trends to pay attention to in 2018, according to AHIMA.

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

The just-closed merger between healthcare giant Hackensack Meridian Health and JFK Health does more than combine two New Jersey systems, it actually brings together two powerhouse IT teams.

JFK Health includes the 499-bed JFK Medical Center in Edison, as well as inpatient and outpatient rehabilitation centers, nursing facilities and other services like JFK's Neuroscience Institute, which offers advanced treatment for adult and pediatric neurological conditions.

[Also: How post-merger Hackensack Meridian made one IT team out of many]

The JFK Medical Center will become Hackensack's 16th hospital, an acute care facility that spans both Bergen and Ocean counties. Its other two academic medical centers are Hackensack University Medical Center in Hackensack and Jersey Shore University Medical Center in Neptune.

Both New Jersey health systems are among the 20 winners of this year's Best Hospital IT Departments feature: Hackensack Meridian in the "Super" size category and JFK in the "Medium" division.

[Also: JFK Health System preps for big changes, growth ahead of move to Epic]

Hackensack-Meridian itself was created out of a merger,  the July 2016 mega-deal uniting Hackensack University Health Network and Neptune-based Meridian Health.

In its profile this year, Joseph Mannion, MD, Hackensack Meridian's CIO, noted that since that merger the Hackensack Meridian IT team exists in "essentially three different locations." This past summer, those 400-plus employees gathered on a Jersey Shore beach: "It was a great time – some people hadn't even met face-to-face yet," he said. "There's essentially a good 65 miles between the furthest northern office and furthest southern office."

Now, with the addition of JFK, the health system adds another 75 staffers in IT and will continue its move away from its best-of-breed environment (McKesson, GE, etc.) and toward the Epic platform onto which Hackensack Meridian is consolidating. 
Culture is critical in situations such as those, said JFK's CIO Indranil "Neal" Ganguly, told Healthcare IT News.

"At JFK, we have worked hard to create a culture of open communication that has ensured that our teams are all working towards a clear and common goal," he said. "Our IT team is proud about the value they deliver to the health system and I think that gives everyone a great sense of purpose."

In addition to the merger, Hackensack also just announced a $12 million investment to expand the cardiac catheterization lab at JFK Medical Center. The project will add a treatment suite that will consolidate non-invasive cardiac diagnostic services like echocardiograms, EKG and vascular studies into one location, Hackensack said in a statement.

The system's said that merging makes them the biggest system in New Jersey, outgrowing Robert Wood Johnson University Health and Barnabas Health, which merged into RWJ Barnabas in 2016.

Hackensack and JFK first announced the deal last November. Then in May, the plans were confirmed pending regulatory approval.

With the addition of JFK, Hackensack Meridian Health now employs nearly 33,000 team members, 6,500 staff physicians and 4,520 beds. In total, the network now boasts more than 160 patient care locations that also include ambulatory surgery centers, home care, long-term care, assisted living facilities and other sites.

The newly-expanded network also touts two children's hospitals: Joseph M. Sanzari Children's Hospital in Hackensack and K. Hovnanian Children's Hospital in Neptune, as well as nine community hospitals: Ocean Medical Center in Brick, Riverview Medical Center in Red Bank, Mountainside Medical Center in Montclair, Palisades Medical Center in North Bergen, Raritan Bay Medical Center in Perth Amboy, Southern Ocean Medical Center in Manahawkin, Bayshore Medical Center in Holmdel, Raritan Bay Medical Center in Old Bridge, Pascack Valley Medical Center in Westwood. Two rehabilitation hospitals, JFK Johnson Rehabilitation Institute in Edison, and Shore Rehabilitation Institute in Brick, also help make up the network.

Click here to learn more about how we chose this year's winners.

Healthcare IT News Editor Mike Miliard contributed to this report. 

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

The U.S. Department of Veterans Affairs’ EHR contract with Cerner was set to be signed this fall, but a new report from Politico found that it’s been held up over disagreements between executives on the definition of interoperability.

VA Secretary David Shulkin, MD, selected Cerner in a no-bid contract in June to replace the agency’s legacy VistA EHR as a way to align data between the VA and the Department of Defense, which already runs on Cerner. The contract is estimated at about $10 billion or more.

[Also: VA to require Cerner prioritize interoperability, secure data exchange in EHR project]

While the road has been bumpy – EHR developer CliniComp has sued the government, among other delays – Shulkin has been committed to its choice in selecting Cerner for the replacement.

However, Shulkin has pushed back the expected fall deadline, as Cerner’s definition of interoperability was too limited, covering only documents called CCDAs, or Consolidated Clinical Document Architecture.

[Also: VA likely wasted $1.1 billion on multiple efforts to modernize EHR, GAO says]

The meeting between VA and Cerner last month was tense, Shulkin told Politico: “To say it wasn't a good meeting would be an understatement."

Interoperability is crucial to Shulkin’s IT modernization plan. In December, the VA released its report on the functional requirements expected from Cerner. Not only is Cerner expected to provide a seamless platform between DoD and VA, interoperability must be far better than the industry standard.

“The Contractor is required to collaborate with VA affiliates, community partners, EHR providers, healthcare providers and vendors to advance seamless care throughout the healthcare provider market,” according to the work statement.

The goal is to enable access and data sharing, along with a security framework to support end-to-end healthcare clinical and business operations. As the VA has been leaning on its VA Choice Program, which extends covered services for veterans as a stop-gap solution for its wait-time issues, interoperability must also be possible between those private providers.

In the interim, Shulkin and his team are using the delay to work with other IT leaders, which he believes will improve outcomes for veterans.

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

Roseville, California-based Adventist Health executives announced the health system would hand over its revenue cycle management services to health IT giant Cerner. 
 
With this new engagement, Cerner will assume day-to-day management of Adventist Health’s revenue cycle and also its clinical applications. 

Adventist is not alone in moving applications into a hosted datacenter environment. More and more hospitals, in fact, are subscribing to cloud-based services for analytics, EHRs, clinical decision support and revenue cycle, among others.

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

Technology consultancy IDC projected that overall spending on cloud services is poised to double by 2021 to surpass $530 billion. 

Adventist is a nonprofit integrated health system that serves more than 75 communities on the West Coast and Hawaii. The health system and Cerner already work together, but Adventist Health CEO Scott Reiner said the expanded partnership will help the health system create a patient journey that can scale as its mission evolves to the benefit of patients and communities. 

Jeff Townsend, executive vice president and chief of staff for Cerner, said the additional Cerner work with Adventist makes for a more aligned and embedded partnership.

Revenue cycle management has become one of Cerner’s sweet spots. In announcing the third quarter 2017 results in October, Cerner President Zane Burke highlighted the potential.

“We have meaningful growth opportunities in revenue cycle and population health, where our solutions and services help our clients navigate the shift from fee-for-service reimbursement to reimbursement based on value and quality,” Burke said.

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

Following its October report examining some of the core functionalities most widely in use by population health vendors, a new report from research firm KLAS offers more advanced insights on the specific performance of vendors.

Among its findings, KLAS showed that integrated delivery networks and clinically integrated networks favor analytics capabilities of vendors such as Health Catalyst, Arcadia and Philips Wellcentive.

Those three "are the most consistent in delivering satisfaction across multiple PHM verticals, specifically the data-focused verticals," according to KLAS. "Health Catalyst does well at developing new tools and working closely to help customers manage their PHM goals and priorities. Arcadia and Philips Wellcentive are highlighted for accommodating multiple types of data and offering a breadth of analytics functionality."

[Also: Clinical analytics market set for big growth worldwide]

Meanwhile, respondents to KLAS reported average satisfaction with the pop health tools offered by the big EHR vendors, despite their broad deployment.

"This is partly because customers’ needs increase in complexity as broader deployment is achieved, said KLAS researchers.

There were some bright spots, however: "Amid the mediocre feedback, clients do report some notable benefits, including integration that helps drive clinician engagement (e.g., eClinicalWorks and Epic) and the availability of patient portals, which many third-party solutions don’t offer. athenahealth, in particular, is highlighted for their functional, easy-to-use portal. Allscripts customers praise the easy-to-use care management functionality and dbMotion’s data-aggregation capabilities."

[Also: Philips acquires VitalHealth to bolster population health portfolio]

In an effort to arrive at some standard for the core competencies that should be expected from population health tools, KLAS gathered executives from providers, vendors, services firms and payers to help identify six types functionality required for PHM – data aggregation, data analysis, care management, administrative/financial reporting, patient engagement and clinician engagement – with further definitions of basic and advanced capabilities for each of the six.

"As providers look to move to comprehensive PHM platforms and leverage the most functionality they can from a single vendor, the question arises as to whether any vendors perform well across all six PHM verticals," researchers write. "While the reality today is that vendor performance can vary widely from vertical to vertical, some vendors offer more comprehensive options that more consistently meet customers’ technology and support needs."

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

Allscripts continues to be in acquisition mode, further building out its client base in the ambulatory space by buying Practice Fusion for $100 million in cash. The deal is expected to close in the first quarter of 2018, officials said.

The addition of San Francisco-based Practice Fusion, whose cloud-based electronic health record is aimed primarily at small, independent physician practices, will give Allscripts a larger footprint in outpatient settings.

It's the second move in less than six months – following the acquisition of McKesson's health IT business in August 2017 – designed to expand the Chicago vendor's nationwide market share.

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

Some 30,000 ambulatory sites, serving about 5 million patient each month, currently use Practice Fusion EHR, practice management, e-prescribing, lab and patient portal technology.

Allscripts also sees the company – which was founded as a startup a dozen years ago and grew as a free, web-based EHR to help small doc practices earn meaningful use incentives – as a way to expand its access to clinical data that can help it innovate in an array of areas: analytics and interoperability, life sciences and clinical trials.

[Also: Two maps show just how much Allscripts boosted its EHR footprint by buying McKesson's tech]

"Combined with Practice Fusion, we expect Allscripts to continue to drive innovation in addressing gaps-in-care, improving clinical outcomes and real-world-evidence research," said Allscripts President Rick Poulton in a statement. "Plus, Practice Fusion’s affordable EHR technology supports traditionally hard-to-reach independent physician practices, and its cloud-based infrastructure aligns with Allscripts forward vision for solution delivery."

Poulton said existing Practice Fusion clients would benefit from the deal, given new access to Allscripts technology.

"Allscripts' highest priority remains to successfully meet healthcare providers’ highly complex needs as we enable them to lead the change to smarter care," he said.

Healthcare organizations across the country now rely on a variety of technologies to prevent medication errors, yet patients remain vulnerable during care transitions, according to a recent survey of 153 physicians, nurses and pharmacists conducted by HIMSS Analytics.

“Even though organizations have implemented a variety of information and medication technologies, many healthcare providers continue to experience significant challenges with medication management – all the way from the procurement of drugs through to the administration,” said Patricia Wise, RN, vice president of healthcare information systems at HIMSS.

More than 50 percent of the respondents who participated in the 2017 Medication Management and Safety Study stated that the greatest gap in medication management occurs when transitioning from one place to another and at the patient bedside. Care transitions are especially vexing because “most patients don’t arrive or depart with one source of truth,” according to Wise.

Joyce Sensmeier, RN, vice president of informatics at HIMSS, agrees. “That time when one nurse is turning over patients to another nurse is critical because, as the receiving nurse, you have to make sure you're getting all the right information about your patients. The system should bring the most current information forward to the clinician who is taking over,” Sensmeier said. “Nurses rely on the technology to get it right but often disparate systems result in nurses running, hunting and gathering. So, they are running around, getting medications, coming back to the patient’s room. They can easily be interrupted three times and that could affect medication administration.”

Indeed, there are numerous glitches that could potentially introduce error into the medication administration process. Consider the following: When a patient at an Oregon hospital needed an intravenous anti-seizure medication called fosphenytoin, clinicians accidentally administered rocuronium, which caused the patient to stop breathing and go into cardiac arrest, according to a report published in The Bulletin. While it was obvious that a mistake was made, it was not immediately clear as to what went wrong during the medication process.

“There are a number of steps in there,” said the hospital’s chief clinical officer, “We’ve never had anything like this happen here. We are in the process of that analysis right now. Before we say exactly what happened, we’re going to make sure we’re accurate about [it]. We do know there was a medication error. We acknowledge that. It’s our mistake.”1

Healthcare organizations are leveraging technology to help eliminate errors.  More than 80 percent of survey respondents indicated that their organizations have implemented a single EHR – a solution that could potentially help to provide a “source of truth” during care transitions. And, more than 70 percent of the clinicians surveyed acknowledged the value of moving toward a single vendor for other medication management technologies as well.

Indeed, as various technologies become more integrated, patient care could potentially become safer. “More hospitals are integrating their medication management technologies with the EHR and that is making it possible to reduce the risk of medication errors and fatalities, while making it simpler and more streamlined for nursing,” Sensmeier said.

She further explained that integration between the smart infusion pump and the EHR, for example, could eliminate medication errors as nurses will no longer have to calculate the intravenous dosage and drip rate. “Ideally, such integration should significantly decrease errors, but there are a lot of moving parts associated with connecting the pump to the EHR, as well as to the patient,” she added.  

While this integrated technology will never completely stop clinicians – who are human – from making errors, it can help to create the safeguards that prevent errors from reaching patients. As a result, organizations can not only protect patients but also cut the costs associated with medication errors, which were estimated to run in excess of $2 million annually by respondents who work at hospitals with more than 250 beds.

“It all goes back to the importance of improved systems,” said Erica Mobley, director of operations at the Leapfrog Group, a national non-profit organization dedicated to advancing the quality and safety of American healthcare. “We all recognize that hospitals are staffed by people, and people make mistakes. Unfortunately, when people make mistakes in healthcare, lives are at risk. No one wants to harm patients, so we need to have the systems in place so that when people do make mistakes, the mistakes do not reach the patients.”

Reference

1. Bannon, R. Error at St. Charles Bend results in patient’s death. The Bulletin. http://www.bendbulletin.com/localstate/2654383-151/error-at-st-charles-b...

“Clunky,” “burdensome” and “not user-friendly” are phrases often tossed around when describing EHRs since the industry made the switch from paper records. But not all physicians are dissatisfied with the technology. In fact, a new report from Reaction Data found that happiness with an EHR may depend on care setting.

Of the 39 percent of physicians happy with athenahealth’s platform, for instance, 50 percent were in the ambulatory setting, while only 13 percent of its acute care physicians had similar satisfaction. Another 19 percent were on the fence about the EHR.

To get these numbers, Reaction Data analyzed information from tens of thousands of physicians across the country, focusing on those who are satisfied with their EHR.

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

Epic also scored big with satisfaction, with 45 percent of users happy with the EHR. Of those, 48 percent were in the acute setting and 41 percent in ambulatory care. Around 22 percent were on the fence.

Ambulatory physicians showed overall happiness with their GE EHRs, the vendor’s primary market. But at the same time, 27 percent of users were on the fence.

Another surprise was that despite the controversy surrounding eClinicalWorks last year, 53 percent of users are happy with the EHR platform overall, all in the vendor’s ambulatory market. Although, 29 percent were on the fence.

The biggest winner was Practice Fusion, with a whopping 70 percent satisfaction rate overall in the ambulatory setting (the vendor’s marketplace) and only 5 percent of users on the fence about the product.
This is big news for Allscripts, which just announced the acquisition of Practice Fusion for $100 million, as Allscripts was one of the vendors on the low-end of satisfaction ratings among providers.

Only 16 percent of users are happy with Allscripts’ EHR, 11 percent were those in the acute setting and 18 percent ambulatory. Further, 12 percent were on the fence about the product. Buying Practice Fusion may help Allscripts improve its rank among physicians.

Cerner was another upset – only 22 percent of users said they were happy with the EHR, 25 percent in the acute setting and 19 percent ambulatory. And another 22 percent said they were on the fence.

Even fewer physicians were happy with their Meditech EHRs at only 15 percent. 

Further, 16 percent of ambulatory organizations and 11 percent of acute facilities plan to switch EHR vendors.

“For better or worse, EHRs have become, in many ways, the operating system of a healthcare organization. And as such there’s simply no way around it. Perhaps that’s why most physicians hate their EHR – they have no choice but to use it,” the report authors wrote. “Even the most publicly maligned EHR vendor has some organizations and physician users who are truly happy with them. Once vendors start profiling their ideal customer base, dissatisfaction will decrease, as will the churn rate.”

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

Meditech is working with population health management company Arcadia Healthcare Solutions, which will help integrate new data into its web-based electronic health record.

Both companies said the partnership will build on their respective expertise, with Meditech's enterprise clinical database merging with claims and other data, including information from other EHR vendors, from Arcadia.

"This collaboration with Arcadia Healthcare Solutions will strengthen Meditech's population health offering through the inclusion of data such as risk scores and gaps in care, empowering our customers to better understand their populations, while also providing tightly integrated care management workflows to translate that understanding into action," said Meditech Executive Vice President Hoda Sayed-Friel in a statement.

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

Arcadia's experience aggregating data from more than 40 different EHR vendors, along with the claims data it collects, can help provider a fuller picture of how care is delivered both in and out of network, officials said. Its data will help Meditech's provider customers hone their treatment plans and bolster their financial viability as they navigate a value-based landscape.

"As healthcare systems take on risk-based contracts, they need visibility into care provided across complex networks," said Arcadia CEO Sean Carroll in a statement. "Meditech will be able to provide its customers the ability to push actionable data in the EHR at the point of care, accelerating performance under risk."

Arcadia's data will be embedded into clinical delivery workflows within Meditech's Web EHR. The extra elements will give providers added insights to help them understand the construct and risk stratification of their patient populations, utilization of resources, costs and related impact on achieving quality outcomes officials say.

"By working with Arcadia to incorporate this robust data set within the  Meditech EHR, we are positioning our customers well for the healthcare paradigm shift underway," Sayed-Friel said.

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

Natural language processing technology is being integrated with electronic health records and finding its way into the big data and analytics realms, often focusing on enhancing provider workflow and clinical documentation. And for the last few years, tech vendors including 3M, Apixio, Dolbey Systems, Health Fidelity, Linguamatics and Nuance, as well as enterprise IT big guns IBM and Microsoft, have been bringing NLP tools to the healthcare market. 

NLP has challenges, of course, but it can offer important benefits when used wisely, said Anupam Goel, vice president of clinical information at Chicago-based Advocate Health Care. 

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

Another is where NLP is gaining traction is among health systems reaping is the of NLP technologies to advance value-based care initiatives. 

NLP for value-based care

Mount Sinai Health Partners announced this week that it is implementing a natural language processing-powered risk adjustment system to advance is value-based care initiatives. 

With more than 300,000 members enrolled in various risk-sharing programs across multiple payers, Mount Sinai Health Partners, a clinically integrated network formed by Mount Sinai Health System, was seeking to develop a risk adjustment program that could maximize the performance of its existing risk arrangements and expand its participation in value-based care programs.

Mount Sinai Health Partners specifically wanted to leverage natural language processing technology in an attempt to optimize the accuracy and completeness of its risk capture. As a result, the IDN entered into a multi-year arrangement with Health Fidelity to help set up a comprehensive program with the Health Fidelity HF360 Risk Adjustment natural language processing software. 

Health Fidelity initially conducted an HF360 Blueprint assessment to identify and quantify the risk adjustment optimization opportunity, which Mount Sinai Health Partners said helped it recognize the potential of a successful risk capture strategy.

"We needed to develop a holistic risk adjustment strategy as we continue our growth in this market," said Michael Berger, vice president of population health informatics and data science at Mount Sinai Health Partners. 

NLP: Now is the time

While NLP can offer value-based care and advanced diagnostic benefits, it depends heavily on the specifics of how clinicians enter their documentation, Advocate’s Goel said.

That said, Goel added that now is the time for NLP. 

The technology has satisfactorily evolved to be useful rather than counterproductive, and the benefits – ease-of-use, a shorter window between clinical documentation and the activation of care teams – make it a worthwhile investment.

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

Clinicians at Ochsner Health System in New Orleans will now be able to access a patient’s prescription history directly within their Epic EHR system. Ochsner tapped Appriss Health for technology that enables integration of state prescription drug monitoring program information directly into the EHR.

A Prescription Drug Monitoring Program or PDMP monitors drug diversion and abuse. PDMPs also help identify clinicians with patterns of inappropriate prescribing and dispensing, and assists law enforcement in cases of controlled substance diversion. 

[Also: Michigan law requires providers check state's PDMP before prescribing opioids]

Hospitals and health systems are more commonly adding capabilities to address the opioid epidemic. Intermountain, for instance, said in August it is equipping its Cerner EHR with new default order sets and other prompts specifically designed to aid physicians treating patients with chronic pain. 

An estimated 2 million Americans are addicted to opioids, and approximately 25 million suffering daily chronic pain, according to the National Institutes of Health. Louisiana is the sixth-highest opioid prescribing state. 

“This is not a ‘do not prescribe project,’” said Richard Guthrie, MD, Chief Quality Officer at Ochsner. “This is about best managing our patients, their pain and mitigating their risk.”

[Also: Indiana will integrate PDMP into EHRs statewide to fight opioid crisis]

To that end, Appriss Health’s PMP Gateway provides access to prescription drug monitoring program data, analytics and other resources within care team workflows real time to provide informed clinical decisions at the point-of-care.

Prior to working with Appriss Health, physicians and pharmacists needed to log into a separate website to retrieve a patient’s controlled substance dispensations from the state database and then cross-reference the data with a patient’s health information – a time-consuming process.

“The purpose of this initiative is to provide near-instant and seamless access to critical prescription information to all prescribers and pharmacists across our health system,” said Debbie Simonson, Vice President of Pharmacy Services at Ochsner. “We are creating a more complete picture of our patients as we make better informed clinical decisions about appropriate medical treatment, while engaging in more ‘real’ conversations with our patients about their health and well-being.” 

Simonson also noted the PDMP has proven to be an effective tool in helping to stop addiction before it starts.

“As we strive to build a culture of patient safety and continued quality improvement at Ochsner, we believe that PMP Gateway will help to increase overall utilization of PDMP information,” Guthrie added.

PDMP data and analytics are integrated into physician and pharmacist workflow through EHRs and pharmacy management systems in 32 states via Appriss Health’s PMP Gateway solution.

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

Texas Hospital Association announced that it is now using Smart Ribbon analytics technology to show physicians actionable clinical and financial data atop their electronic health system. Baylor Scott & White Health, in fact, has already deployed THA Smart Ribbon, which was created by IllumiCare and the Texas Hospital Association’s Center for Technology Innovation.

THA Smart Ribbon is designed to help physicians be more informed about the cost and clinical necessity of the tests they order. Studies have shown that the more docs know about the price tag and impact of specific tests when they're at the point of care, the more likely they are to order fewer or less costly procedures and medications.

[Also: Meditech partners with Arcadia to add claims, risk stratification data into its EHR]

Smart Ribbon uses a patent-pending, EHR-agnostic technology that taps HL7 feeds to gather clinical data and leverages existing authentication and permission infrastructures. IllumiCare says the tool can show physicians real-time cost and risk data, including detailed information about medications, labs and radiology.

At Baylor Scott & White, doctors will be shown data at the point of care with a "ribbon" of information, according to THA, that can help them better evaluate the need for previously performed tests – X-rays, EKGs, labs – and help them determine the necessity of the test, cost to the patient and health system and impact on the individual’s health.

Physician ordering can affect more than 85 percent of hospital costs, studies have shown, so the Smart Ribbon data, which "hovers" over the EHR at the point of care, can help docs think more strategically about the tests they call up.

Stephen Sibbitt, MD, Chief Medical Officer at Scott & White Medical Center–Temple, said Smart Ribbon is first being deployed at that system first.  

"The benefit of an integrated delivery system with our electronic medical record has allowed us to reduce unnecessary testing and care, which ultimately benefits the patients and lowers healthcare costs overall,” Sibbitt said. 

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

The Green Mountain Care Board in Vermont has approved the enterprise implementation of a $151.7 million Epic EHR system across four hospitals that make up the University of Vermont Health Network.

UVM Health Network’s new Epic system, which is expected to take six-years, will replace a variety of legacy technology, and some paper-based documentation.

The announcement comes one day after Epic rival Allscripts said it is acquiring cloud-based EHR maker Practice Fusion for $100 million – a move that followed its August acquisition of McKesson’s EHR and health IT unit.

[Also: Allscripts buys Practice Fusion for $100 million]

UVM Health Network officials said the new EHR system would cost less than replacing and maintaining the outdated systems in place today.

While acknowledging $151.7 million is substantial, board members noted it was less than the $200 million it would cost to maintain the old disparate systems. UVM officials plan to pay for the project in part through employment reductions and efficiencies.

The installation will include the University of Vermont Medical Center, Central Vermont Medical Center, Porter Medical Center and Champlain Valley Physicians Hospital.

Three other affiliates – Alice Hyde Medical Center, Elizabethtown Community Hospital and the Visiting Nurse Association of Chittenden and Grand Isle Counties – will connect at a later date, officials stated.

The board also said it expects UVM’s new system will more easily connect with the existing statewide health information exchange and might prove beneficial for health care reform and research.

In addition to finding the need for a shared EHR is clear, GMCB members concluded the cost of the project was reasonable and would improve the quality of healthcare in Vermont. The board set forth a series of conditions to ensure timely and financially-prudent implementation and is requiring measurement of the impact on quality of care and the administrative burden on providers.

The board also directed the system be designed to support provider and patient decision-making.

The UVM Health Network first announced its plans a year ago when it filed the required certificate of need, or CON application, with the state of Vermont.

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

Brent Shafer will take the helm at healthcare IT giant Cerner on February 1, the company announced today. He will also lead the board of directors as chairman.

Formerly, Shafer served as CEO of Philips North America. Over 12 years, he played a key role in helping Philips develop and strengthen its healthcare focus, increase its profitability and grow its market share, Cerner officials noted in announcing the move. 

At Philips North America, Shafer oversaw the largest market of global technology, a portfolio that includes a wide range of solutions and services covering patient monitoring, imaging, clinical informatics, sleep and respiratory care as well as a group of market-leading consumer-oriented brands.

“For decades, Cerner has built its reputation on meaningful innovation and driving client value,” Shafer said in a statement. “This company’s history of remarkable, sustained growth is testament to a strong leadership culture, and I’m excited to celebrate many new milestones with Cerner associates around the world.”

He added that his commitment to Cerner clients, shareholders and associates worldwide is to continue to be the catalyst for real and effective improvement across healthcare.”

Shafer was appointed CEO of Philips North America in February 2014. Previously, he was CEO of the global Philips Home Healthcare Solutions business, He has had additional senior leadership positions with Philips and at other companies, including GE Medical Systems, Hill-Rom Company and Hewlett-Packard.

Cerner Co-Founder Cliff Illig, who has served as the company’s interim and chairman of the board since Cerner co-founder and CEO Neal Patterson died on July 9, 2017, will resume his role as vice chairman of the board, effective Feb. 1.

“Brent is a proven chief executive who has helped lead the growth and strategies of a complex, multinational organization over a number of years,” Illig said in a statement. “He is committed to innovation, with extensive knowledge of healthcare, technology and consumer markets and an exceptional skill set that complements Cerner’s strong leadership team.

“The addition of Brent to our leadership team positions Cerner well for our next era of growth.”

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

As the opioid crisis continues to ravage the United States, hospitals and health systems are on the front lines of the battle. Commanding majorities of C-suite leaders say their organizations see the epidemic as one of their top priorities – and are marshaling technology resources to help fight it.

A new survey from Premier shows that 90 percent of execs from member health systems are focusing on the opioid crisis as an imperative for 2018. Hospital leaders are focusing their efforts on assessing patients to evaluate their pain levels upon admission, educating their staff about resources for safe opioid use and exploring alternative methods for pain relief, the study shows.

[Also: Ochsner integrates opioid monitoring tool into its Epic EHR]

Patient education is key too, of course, and health systems are focusing on engaging those patients on smart pain management treatment and safe use of opioids. They're also collaborating with state, local and community partners.

But in the opioid battle, technology may be among the most important tools: Health systems are increasingly relying on advanced clinical decision support, automated patient alerts, e-prescribing practices and continuous electronic monitoring of patient-controlled analgesia, according to Premier.

Premier CEO Susan DeVore said Premier’s members are striving to improve pain management issues to reduce misuse and addiction. 

[Also: Intermountain tweaks Cerner EHR in bid to reduce opioid prescriptions]

To that end, Premier offers its members medication surveillance tools that can give them real-time alerts on high-risk drugs and dangerous drug-drug interactions, monitoring patients who are prescribed high-dose or long-acting/extended-release opioids. The technology also offers advice and recommendations for co-prescribing naloxone and feature educational tools for patient and families who may need to administer naloxone in cases of overdose.

Those hospitals taking part in Premier’s Hospital Improvement Innovation Network, meanwhile – it's part of the Centers for Medicaid & Medicare Services Partnership for Patients program – are also participating in an initiative to measurably improve pain management among providers, clinicians and patients/families.

Premier also recently launched its Safer Post-operative Pain Management pilot program, with more than 30 hospitals working together to redesign care delivery processes to better manage pain and the potential for drug addiction.

The alliance has also published a Safer Pain Management Toolkit for its 3,750 hospitals and 130,000 provider members. If provides a repository of all Premier group purchasing contracts, suppliers, services and programs in the pain management space and allows members to search for alternative therapies, devices that monitor oxygen and carbon dioxide levels to avoid respiratory-related side effects and infection prevention treatments to improve the immune system’s response to opioids.

The toolkit also offers analytics on opioid visits, utilization and prescribing practices in the emergency department at nearly 650 Premier hospitals, allowing other providers to benchmark themselves against against national data.

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

NTT Data Services has partnered with Pieces Technologies, a developer of clinical artificial intelligence software, with the aim of helping hospitals improve care quality and decrease the costs by using natural language processing and AI-based systems.

Specifically, NTT Data will integrate the Pieces Decision Sciences software into its technology suite that includes data integration services, analytics capabilities, cloud services and consulting. 

[Also: Prioritizing development of AI in workflow is biggest challenge for IT shops in 2018]

Artificial intelligence in healthcare is growing out of its infancy stage. It's been proven to work, it's been put to use in real clinical settings. But adoption has been slow. Further, healthcare has only explored the tip of the AI iceberg.

But experts say hospitals are beginning to witness AI innovations emerge in healthcare and other industries, whether that is pinpointing complex patterns in data, genomic sequencing or personalized medicine. 

To that end, the cloud-based Pieces Decision Sciences platform uses AI and natural language processing to power key algorithms throughout a patient's care journey in real time. The software is integrated with electronic health records and uses predictive modeling, clinical NLP, machine learning and AI directly at the point of care to aid real-time decision making.

NTT Data officials said enables hospitals and health systems to lower readmissions and avoidable hospitalizations, reduce excess length of stay, minimize the risk of healthcare-associated infections, and decrease complications from sepsis and inpatient deterioration.

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

The state of value-based reimbursement efforts has been uncertain. Many healthcare organizations are indeed pursuing newer strategies to replace traditional fee-for-service care while reducing costs and improving quality, but progress has often been halting.

Still, experts from Cedars-Sinai, CVS Health, Blue Cross NC and Harvard Pilgrim Health Care say they're quite optimistic for the future of value-based care in 2018 and beyond.

[Also: Natural language processing tools take aim at value-based care through risk-sharing programs]

In the area of health IT, the shift to value-based care is fueling new uses for data and has the potential to reinvigorate the electronic health records that many feared had gone stale, said Scott Weingarten, senior vice president and chief clinical transformation officer at Cedars-Sinai and an innovator in the value-based care space.

"I believe that natural language processing, machine learning and artificial intelligence have the potential to significantly improve the interpretation, understanding and usefulness of information documented in the electronic health records and other information sources," Weingarten said. "I believe that these advances will enable provider organizations to unlock the promise of EHRs and other technologies and achieve a greater clinical and financial return on their technology investments."

[Also: Why more tech vendors are targeting ACOs with analytics, care management tools]

With regard to the value-driven model, digital health systems for virtual care can help the industry ease the transition if adopted soon and used wisely, said Michael Sherman, chief medical officer and senior vice president of health services at insurer Harvard Pilgrim Health Care. He oversaw the first value-based care deal between Harvard Pilgrim and Amgen, which focused on drug performance.

"Through enhanced utilization of emerging technologies such as telemonitoring, moving care to the home – including for conditions previously requiring hospitalization – providing an enhanced primary care experience, many through a combination of in-person and virtual care," Sherman said. "In many cases, these companies are bypassing the health plan and being offered directly to large employers."

Given that these new approaches appear to be gaining real traction, those who choose to ignore these new entrants do so at their own peril, he added.

On another front, value-based care strategies must be designed and implemented with a focus on the consumer and a firm commitment to enhancing the patient experience, said Patrick Conway, president and CEO of Blue Cross NC and former head of innovation at the Centers for Medicare & Medicaid Services, where he advanced bundled payment models.

"All of our work to improve quality and outcomes and reduce costs should be with an eye toward giving consumers greater value and an overall better experience," Conway said. "Our healthcare system in the U.S. is fragmented, which only confuses people. The partnerships that providers and health plans have begun need to lead to tighter integration and more sharing of data to create a better-coordinated experience for consumers."

And value-based programs will succeed based on the results they deliver – and drug manufacturers are finally listening, said Tracy L. Bahl, executive vice president, health plans, at CVS Health. He has been instrumental in working with the company's health plan clients to explore opportunities to integrate value-based care models.

"It is the consumer who will determine our fates more than any law or regulation. How effective we are at simplifying this ridiculously fragmented and complex space for the consumer and driving tangible value in their lives will determine how successful any of us are," said Bahl. "If there is a mistake to be made, it's in implementing a 'value-based program' for the sake of having a value-based program.

"You see this a lot in 'value-based' programs with drug manufacturers – many look interesting but have failed to produce tangible results," he said. "We've been able to partner with a few manufacturers in innovative ways that we believe will drive tangible results for our customers."

The four executives were convened at a roundtable hosted by Chasm Partners, a retained search firm focused on placing talent in high-growth venture-backed companies and specializing in industries including healthcare technology and Big Data.

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