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    DaVita announced that it will implement a new EHR from Epic Systems and employ Epic’s Care Everywhere Network.

    The company, which provides kidney dialysis across the United States and in 11 countries around the world, said the new electronic health record EHR platform will enable it to grow the capabilities within the DaVita Physician Solutions' chronic kidney disease EHR platform.

    The Epic EHR replaces DaVita’s Falcon Platinum System, which was homegrown. DaVita will also employ Epic’s Care Everywhere Network.

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

    "Our goal is to create technology solutions for physicians that are easy to use and are efficient in providing the right data at the right time to improve quality outcomes," Derek Schoonover, VP of information technology at Davita, said in a statement.

    Schoonover added that combining Davita’s clinical expertise in kidney care with Epic technologies will make for a better platform and better patient outcomes.

    Chronic kidney disease and end-stage renal disease are major drivers of cost, and coordination is critical. By leveraging Care Everywhere interoperability, noted Alan Hutchison, vice president of population health at Epic, DaVita will be able to collaborate and to provide the Epic community information and insights to help reduce costs and facilitate care. The number of end-stage renal patients on dialysis is expected to double to 850,000 in the next decade. 

    DaVita did not say how much it will spend on the new Epic electronic health record platform.

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

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    DaVita swaps homegrown EHR for Epic
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    DaVita swaps homegrown EHR for Epic
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    The global organization will also tap Epic’s Care Everywhere Network as part of its new electronic health record deployment.
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    LAS VEGAS -- The tech world descended upon Las Vegas this week for the annual Consumer Electronics Show, and plenty of health IT’s biggest players were in attendance. While much of the discussion was on consumer-friendly health tools and novel digital interventions, there were still a handful of products and discussions between executives and entrepreneurs focused on healthcare’s largest roadblocks — namely, data management and analytics.

    “Everyone loves playing in their own sandbox. How does it get to the point of sharing that data? How do we have EMRs being shared across systems today?” Pat Keran, VP of innovation and R&D at Optum Technologies, said during a roundtable discussion at CES’ Digital Health Summit. “I think data sharing is first and foremost, but even for the data that we have, how do we effectively analyze that today? How do we use artificial intelligence, deep learning, those types of things that are starting to evolve right now into being a lot more effective for where we’re at today?” 

    With more continuous sensors entering care, a rising challenge is separating the useful data from noise and extracting actionable insights. While most speakers focused on how to address these issues in the consumer space, others highlighted the gaps that health systems and insurers still have to address.

    “We really need to start thinking about the caregiver. Until we get all the data integrated and all the interoperability and everything, there are people in the lives of every patient you serve, already there,” Stefani Benefield, VP of health innovation at Humana, said during the same session. “Make sure that the data can somehow get to them … you may not be able to get it into one beautiful care plan yet, and I think we would all love that, but I think we have to be able to trust and put data with people and make sure that you do it in a way that is scalable and gives them just enough information. I actually think [the insight is] there, we just need to get it to the right people.”

    Interoperability, blockchain remain key focuses

    While Benefield and Keran were primarily focused on how to use healthcare data as it is today, there were other speakers looking more toward the future. 

    QuHarrison Terry, director of marketing at Redox and a recent entrant into the world of healthcare data, said that he was baffled by the status quo of siloed data and the reliance on fax machines for medical data transfer. While pitching his company’s platform — a vendor-agnostic API currently employed by hundreds of health companies — he said that these interoperability hurdles need to become a key focus for the industry. 

    Bettina Experton, MD, CEO of Humetrix, described her company’s work with government agencies over the past decade to develop a mobile implementation of theBlue Button initiative, iBlueButton. Interest in the program has led Humetrix to successfully extend its efforts to the national healthcare systems of the UK and France, she said, though roadblocks are continuing to pile up in the world’s largest healthcare market.

    “Back in the US, we had a frustration. We turned medical data into a logical health record for all for your smartphone — that was President Bush in 2004, but it has not quite happened today,” she said during a presentation. “For years we asked CMS to give us an API to make it really easy and sturdy in terms of access to that data for patients to use, so CMS finally responded to the call and this administration, embracing that innovation, is building an API … and we are one of the industry players who are testing that API.”

    At the end of her talk, Experton also hinted at new announcements related to their work with CMS’ API to be announced at HIMSS 2018.

    Still, it wouldn’t be a tech conference without some mention of blockchain. During a fireside chat on the trending technology, Mike Jacobs, senior distinguished engineer with Optum Health, and Jaquie Finn, head of digital health at Cambridge Consultants, both said that they were generally optimistic about blockchain’s role in healthcare, but warned that it should only be applied to tasks in which it is well suited. 

    “[When my clients are making a smart connected device,] if there are three conditions I can see present in the scenario around the data, I will think about blockchain maybe happening: If the data is dynamic; if the current solution that they are going to have is fragmented,; and if there is a suspicion of malicious activity,” Finn said. “Those three things are like a red flag, where we could talk about when designing the system to add some blockchain technology, simply to protect the data.”

    [Also: Blockchain network-as-a-service platform scores $10 million from AMA-backed Health2047]

    Finn said the best applications of the technology she has seen so far in healthcare are those designed to track and prevent the sale of counterfeit drugs and devices. Jacobs — who cryptically noted that Optum “will take a leadership role” in the future of blockchain and healthcare — outlined his own ideas about where blockchain is most likely to make impact, among which were smart, legally-binding automated contracts for payments, and the transfer of health records. 

    “Today in the healthcare world we have islands of information where there’s high costs and reconcilable differences in the islands, [and] a central, stable source of truth makes sense without necessarily having a central authority,” he said. “Those are the big ideas, and we’re pretty excited.”

    Fee-for-service, policy continue to shape health tech

    Digital health executives also spent some time talking about the impact of value-based care and recent healthcare policy on their endeavors. These discussions came to a head with participants lamenting the legacy of pay-for-service models, and their impact on new care-delivery technologies.

    “A lot of the country is really stuck in a fee-for-service model where they don’t know how to adopt telehealth,” Zubin Eapen, MD, chief medical officer for CareMore Health, said during a panel discussion. “They don’t see incentives to do that, and they’re used to just having patients come back to the hospital or back to the clinic, and that’s not what a patient wants or needs.”

    [Also: VA, Cerner EHR deal held up after spat over interoperability definition, report says]

    Feedback on the impacts of policy was largely positive, but with concessions that certain legislature based on the aforementioned pay-for-service healthcare model interrupting services. Here again, telehealth was a prime example, although Renna Pande, MD, chief medical officer of AbleTo, said that certain branches of the government have served as a driving force for more permissive legislation.

    “The VA is surprisingly innovative and creative, despite all of the flak that the VA gets in the press. You know, they were the first to have the EMR — you and I probably trained 15-plus years ago using their EMR, which we see in everybody else’s,” she said during the session. “With David Shulkin at the helm, he’s been very innovative and actually has lowered the barriers to delivering telemedicine and, in fact, creating the ability for providers to not have to be licensed in another state.”  

    [Also from MobiHealth News: In-Depth: News and views from CES 2018]

    Twitter: @dave_muoio
    Email the writer: dave.muoio@himssmedia.com

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    Healthcare at CES 2018: Blockchain, Blue Button and interoperability among hot topics
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    Healthcare at CES 2018: Blockchain, Blue Button and interoperability among hot topics
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    Health data sharing, telemedicine, even federal value-based payment plans were all part of the excitement at the Consumer Electronics Show in Las Vegas.
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    Overuse of copy and paste in electronic health records is a problem. Sure, it's convenient. And it's entirely understandable why it's a common shortcut used by scores of physicians. But it often results in note bloat – unwieldy patient records overflowing with repetitive documentation – that can potentially lead to serious safety risks.

    "Copying or importing text increases the risk of including outdated, inaccurate, or unnecessary information, which can undermine the utility of notes and lead to a clinical error," wrote researchers in a 2017 study in Journal of the American Medical Association.

    [Also: EHRs are overflowing with copy-and-paste records, JAMA study shows]

    The practice of copy and paste has to be reigned in, and one chief medical information officer, writing for the Agency for Healthcare Research and Quality, says that has to start with the physicians themselves.

    Shannon Dean, MD, CMIO at University of Wisconsin School of Medicine and Public Health, penned a column this month for AHRQ's Perspectives on Patient Safety. She began with an example of what can happen when notation gets lazy.

    She cites the case of a 78-year-old man who, "with an alleged history of 'PE' (interpreted by the clinicians as pulmonary embolism) received an unnecessary CT scan to rule out a suspected 'recurrence' of pulmonary embolus.

    [Also: NIST weighs in on EHR copy-and-paste safety]

    "As it happens, years earlier, the abbreviation 'PE' had been used in the electronic note to indicate that the patient had had a physical examination, not a pulmonary embolism!" said Dean. "In a vivid example of copy and paste, once the diagnosis of pulmonary embolism was mistakenly given to the patient, it lived on in the EHR."

    Beyond the risks to patient safety, that also points to the unnecessary costs that can pile up when unwitting clinicians order tests that are based on erroneous and repetitive data.

    Nonetheless, said Dean, too many clinicians still copy and paste as a habit: "Perhaps we are complacent about copy and paste because we remain unconvinced that there is a correlation between its use and patient safety."

    In her article, she surveys more than a dozen studies on the subject, and finds that published research into adverse outcomes isn't as voluminous as one might expect, even if it's understood, intuitively, that the practice isn't ideal.

    So "it is clear that much work remains to be done," said Dean. She points to toolkits like the one put together by AHIMA, and the fact that Epic has rolled out functionality that can "identify the source of every character within a note, whether it is newly typed, imported from another source, or copied and pasted."

    Still, "I am aware of very few organizations that are actively using these tools to educate and mentor clinicians in a systematic way to improve documentation quality," she said.

    While more academic research would be welcome on the correlation between copy and paste and patient safety, she said, it's fairly widely accepted that it's a shortcut that should only be used sparingly and in specific instances.

    Healthcare organizations need to start making use of resources such as AHIMA's toolkits, Epic's auditing features and innovations like natural language processing technology to help physicians do better with their EHR documentation.

    She also points to the OpenNotes initiative, which continues to gain momentum, as another big opportunity: Giving patients the ability to read their own doctor's clinical notes allows them to "hold us accountable for quality documentation."

    But at the end of the day, "physicians need to reestablish ownership of the accuracy of clinical documentation," said Dean. "We must stop blaming the EHR for our carelessness and start educating ourselves about how to use documentation efficiency tools, including copy and paste, more responsibly."

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

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    Doctors must stop blaming EHRs for clinical documentation shortcut failures
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    Doctors must stop blaming EHRs for clinical documentation shortcut failures
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    With copy and paste rampant, UW Health chief medical information officer Shannon Dean says toolkits and vendors can help, but physicians need to take responsibility for proper clinical documentation.
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    Since it launched its virtual care telemedicine program in October 2016, Mission Health in Asheville, North Carolina, has completed 1,200 patient visits. In November 2017, the provider organization saw its highest overall use with 178 total visits; 155 of those were treated via its Mission Virtual Clinic program and 23 were triaged out for additional evaluation and treatment.

    "Since July 2017, we have seen steady growth in the use of Mission Virtual Clinic," said Steve North, MD, clinical director, Mission Virtual Clinic, and a family physician at Mission Health.

    The provider organization uses Cerner for its EHR and Zipnosis for telemedicine.

    "I believe this growth is due to a combination of increased marketing to the community, increased community acceptance of the care delivery, and increased provider acceptance resulting in fewer referrals out," said North.

    Mission Health now is recommending Mission Virtual Clinic in combination with its primary care practices, North added.

    [Also: AHIMA posts telemedicine toolkit to prepare hospitals for wider adoption of tech]

    Beginning this month, patients who are on insurance plans offered by Mission Health Partners will be able to log into their insurance account and access the Mission Virtual Clinic platform. The organization believes this will help patients see Mission Virtual Clinic as an integrated part of the comprehensive care offered through its health system and ACO.

    "The Mission Virtual Clinic is online convenient care for common illnesses from the comfort of the patient's home for only $25, no matter the type of insurance," North explained.

    Because of more and more success stories like Mission Health, telemedicine is on the rise. This month has brought several new developments on the telehealth front, as vendors look to capitalize on the recent momentum of virtual care. Among them: InTouch Health, which has expanded its telemedicine offerings with an eye toward both direct-to-consumer delivery and in-house providers, and Teladoc, which debuted an integrated mobile app with a single, patient-centered point of access to answer a wide array of medical needs.

    [Also: Telemedicine's market momentum prompts vendors to expand, connect with larger patient populations]

    For Mission Health, the telemedicine and EHR technologies are integrated, and there are two levels of integration between the Cerner and Zipnosis platforms.

    "The first is the direct import of all Zipnosis encounters into the Cerner EHR as a distinct 'virtual clinic' note type," North explained. "If a patient does not have an existing chart within our Cerner system, a new chart is created."

    The second level of integration results from Zipnosis' "ZipTicket" protocols, which offer patients an easy way to receive testing for strep throat and influenza through the Mission Virtual Clinic. These results are entered into Cerner by the lab staff and interfaces with the Zipnosis protocol resulting in the correct response being sent to the patient based on the algorithm.

    [Also: Value-based care will reinvigorate EHRs, boost AI, advance home telehealth]

    "Primary care providers then are able to see: the ZipTicket flu swab; rapid strep, with culture for kids under 18; and urinalysis results, in the context of their standard Cerner workflow," North explained.

    Mission Health added a pertussis protocol aimed at addressing an outbreak in its community. The pertussis post-exposure prophylaxis protocol was something it had explored earlier this past fall following a much smaller outbreak in another community.

    "We had about 25 patients with potential exposure come to our urgent care practice and needed to stay in their cars with providers going to the parking lot to treat them and not spread the virus," North said. "At this time, we had already begun education with our Mission Virtual Clinic providers regarding this protocol. We planned to launch on Dec. 15."

    But the spread of a whooping cough outbreak came to Mission Health's attention shortly after Thanksgiving. So Mission Health made the decision to launch the pertussis protocol ahead of schedule, activating it on Nov. 29.

    "On Nov. 30, I led a videoconference introducing the medical directors of the Henderson and Buncombe County Health Departments to the protocol," North said. "We also began a social media campaign and informed our own providers of the pertussis PEP protocol being active."

    One week after the launch, Mission Health had seen three cases treated with pertussis PEP through Mission Virtual Clinic. The provider organization currently is working to expand knowledge of the Mission Virtual Clinic protocol, as well as ways to increase access to this protocol for all patients who may have been exposed.

    North believes, based on Mission Health's experience, that the technology-based way of caring for patients will expand in the future and become more important.

    "The integration of virtual care into all aspects of medical care will continue to grow as patients and providers become more comfortable with the modalities used to deliver this care," he said. 

    "Successful integration of Mission Virtual Clinic into our health system will be seen when our primary care triage nurses and on-call providers recommend Mission Virtual Clinic as a treatment option for patients and we see a decrease in the office visits for the acute conditions treated through Mission Virtual Clinic," said North.

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

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    Mission Health's virtual care success lies in EHR, telehealth integrated workflow
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    Mission Health's virtual care success lies in EHR, telehealth integrated workflow
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    The Cerner EHR adds the Zipnosis telehealth notes after each virtual visit and recently used its integrated platform to address a pertussis outbreak.
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    As people learn more about the crucial role of genetics in health and the cost to sequence genes continues to decrease, the worldwide market for direct-to-consumer genetic tests could triple over the next five years, according to a new report from Kalorama Information.

    The DTC genetic testing market was around $99 million this past years, according to the research firm, and could grow to more than $310 million in 2022.

    Consumers are looking for more control over their own health and healthcare, and with the advent of affordable genetic testing there are new avenues for personalized treatment and precision medicine. Companies that can offer these testing kits stand to see big success in the years ahead, said Kalorama officials.

    [Also: With precision medicine heating up, Genome Medical launches genetic services for employers]

    Beyond the consumer market, rule changes also have something to do with that projected growth.

    "Strong growth is expected through the forecast period due to easing of the regulatory process for DTC genetic tests," said Mary Ann Crandall, analyst for Kalorama Information.

    But there are complications, of course, as consumer tests come to the fore and patients arrive at their doctor appointments brandishing their own genetic data and full of questions and opinions.

    The Kalorama report, The Market for Direct-to-Consumer Genetic Health Testing, comes decades after consumers first started clamoring for access to laboratory tests, officials point out, but at a time where concerns still remain that patients – and not a few physicians – don't always understand what the genetic results mean and just what to do about them.

    Whether it is sequencing that can test for specific illnesses or ancestral tests that can offer valuable information about racial or ethnic predispositions, the number and variety of DTC genetic tests is increasing.

    Meanwhile, Kalorama points out that the 2008 Genetic Information Nondiscrimination Act has enabled consumers to take such tests without having to be concerned that insurers and employers might discriminate based on the results.

    Companies that do DTC testing offer an array of services: predicting adverse reactions to specific medications, estimating susceptibility to various complex diseases and more. The Kalorama report examines a couple dozen companies including 23andMe, DNA4Life, Natera, Veritas Genetics, LabCorp, Quest Diagnostics and others.

    Quest Diagnostics and LabCorp have clear advantages due to their name recognition, a large number of locations and financial strength – but are relatively new to the DTC market. It's smaller labs that have so far been leaders in the space. Others, meanwhile, have specialized in areas like ancestral testing (23andMe) or operate regionally (Sonora Quest Laboratories).

    But as consumers get more comfortable with those companies' offerings, the visits with their doctors are often getting more complex.

    "With the increased use of the Internet for medical information, consumers have become medical consumers not just patients," according to Kalorama. "This has created a change in the doctor/patient relationship as individuals become more knowledgeable about their own health and want more control over their personal information and treatment decisions."

    Physicians, meanwhile, are concerned about giving patients too much access to information they may not properly understand. Even many doctors aren't well-trained in the clinical implications of genetics and genomics.  

    In response to some of these ethical dilemmas about the interpretation and use of genetic test results, many testing companies have employed onsite genetic counselors to help consumers make sense of the information.

    Despite these challenges, "demand by the consumer to unlock their genetic health information will likely triumph over the adversities," said Crandall.

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

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    Direct to consumer genetic testing set for big growth despite clinical and ethical challenges
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    Direct to consumer genetic testing set for big growth despite clinical and ethical challenges
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    A growth projection of 25.6 percent by 2022 is expected, says new Kalorama report, and so are changes in the doctor-patient relationship.
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    The Vancouver Island Health Authority's electronic health record implementation has been fraught with controversy since its launch in March 2016. And the latest investigation, by British Columbia's Ministry of Health, stands by provider complaints: The Cerner project was mismanaged – neither properly planned nor implemented.

    In fact, the report found that had officials leaned on advice or experiences from other Canadian EHR installs, many of the problems could have been prevented.

    The Cerner project went live in March 2016 at Nanaimo Regional General Hospital, Dufferin Place Residential Care Centre in Nanaimo and Oceanside Health Centre in Parksville. But the launch was quickly denounced by many providers -- some even refused to use the technology. This led to Island Health creating some stiff enforcement policies.

    [Also: Canadian Cerner install under investigation again, but mishaps go deeper than the tech]

    British Columbia Provincial Patient Safety and Quality Officer Doug Cochrane launched an investigation into the rollout soon after and found many critical functional deficiencies in the EHR.

    For example, any user could inadvertently order unsafe medication doses. The EHR also had connectivity issues with the barcode reader – among a long list of other system flaws.

    While IHealth addressed some of those issues, BC Health Minister Adrian Dix launched the second investigation into the project in Sept. 2017.

    [Also: Epic notches a first with Canadian EHR install]

    This second report found the crux of provider issues: Deep mismanagement. Those issues, combined with the "long-standing contentious relationship" at Nanaimo Regional General Hospital further exacerbated the situation.

    "The report suggests the culture and governance at NRGH and Island Health has played a part in the IHealth challenges," according to BC officials. "There is a general climate of distrust in the hospital; stakeholders are deeply polarized, entrenched and dissatisfied with the current state of IHealth."

    In fact, barely 50 percent of staff thought they could work collaboratively with leadership to make the project a success.

    Another issue, brought to light by the President of the Nanaimo Medical Staff Association prior to the investigation, was the organization "was in a poor state of readiness when the system was activated."

    In fact, the report found that the majority of nurses are less productive now than when they were on a paper-based system.

    The EHR project, as a result, is seriously delayed and experiencing financial troubles. In fact, the initial $173.5 million budget won't be enough to complete the project. Island Health estimates another $51.1 million is needed to finish the rollout.

    However, EY (which conducted the second investigation) suggested Island Health will need even more funding to wrap the rollout.

    To overcome these issues, Dix said Island Health will appoint a mediator to support stakeholders to move the project forward. The mediator will work with stakeholders to help resolve issues plaguing the organization.

    Further, the mediator will create a work plan with stakeholders on necessary actions to address the report's recommendations. Island Health was directed to adhere to the report findings and map out a realistic plan with adequate funds. The mediator will also monitor plan adherence.

    "Over the past decade, hundreds of millions of dollars have been spent on IT projects that have failed to deliver the outcomes promised," Dix said. "By taking this action today, this government is making sure that we take a more thoughtful approach to these projects by slowing down, properly planning and engaging the right people in the right way."

    While the Nanaimo Medical Staff Association told Healthcare IT News they're pleased their concerns have been validated by the report, the group is disappointed the system won't be suspended until the EHR is redesigned.

    "Patient safety remains a priority for medical staff working in Nanaimo and this is why physicians raised these concerns," President of the Nanaimo Medical Staff Association David Forrest, MD told Healthcare IT News in an emailed statement.

    "That being said, it's promising that government has made the decision… to address the fundamental issues in the relationship between healthcare workers and the Health Authority," he added. "If we're to engage with Island Health to find a solution, we clearly need a change to what's taken place in the past."

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

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    Canadian Cerner EHR investigation finds install to be mismanaged, underfunded
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    Canadian Cerner EHR investigation finds install to be mismanaged, underfunded
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    The Ministry of Health's second investigation into Nanaimo's EHR project found that managers failed to leverage advice that could have helped prevent some of those issues.
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    Physicians are under more pressure than ever before. Kludgy EHR software interfaces, ICD-10 codes, new payment models, those are just the beginning. So it’s no wonder that physician burnout has become a widespread problem for hospitals and medical practices.

    “There are many studies about why doctors feel ‘this isn't the job I signed up for,’ ” Stephen Klasko, MD, said. He pointed to research showing that 71 percent of physicians feel disengaged. Those doctors are more likely to leave, he said, adding that the departures prove costly for hospitals – about $250,000 for each physician who calls it quits.

    Klasko, president and CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health, is teaming up with athenahealth CEO Jonathan Bush to lead a HIMSS18 session about the increasing pressure physicians are feeling as rising expectations show no sign of abating, and concern over physician burnout continues.

    During their HIMSS18 session “Physician Engagement as a Catalyst for Clinical and Financial Improvement,” Klasko and Bush will discuss physician capability and engagement and how to deploy technology that matches provider needs, eliminates work and engages rather than getting in the way of physicians.

    Klasko champions honing leadership skills along the same lines as those often learned in the sports arena.

    “Mid-career doctors who played team sports in school are happier today,” Klasko said. “Maybe it's too late to go back and teach them basketball -- but we can teach them leadership skills.”

    Klasko said hospitals leaders also need to focus on building resilience and optimism among mid-career physicians. And he said that electronic health records will at some point actually make doctor’s working lives better.

    “We tend to overestimate technology in the short run, but underestimate it in the long run,” Klasko said. The first generation of EHRs frustrate many doctors, he acknowledged, “but we have many generations to go and I believe we will see a complete transformation of how we can support patients and their teams.”

    That transformation should also include moving toward a future in which healthcare will be run by teams in many non-traditional locations.

    “We have to design a system with no address, using interdependent teams that include the patient,” he said. “We have to move beyond the hospital as the geographic center of care, and beyond the doctor as the captain of the ship.”

    The session “Physician Engagement as a Catalyst for Clinical and Financial Improvement,” is scheduled for Thursday, March 8 from 4-5 p.m. in the Las Vegas Venetian Convention Center Palazzo G. 

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

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    Solving physician burnout: Interdependent care teams beyond hospital setting could be answer
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    Solving physician burnout: Interdependent care teams beyond hospital setting could be answer
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    Thomas Jefferson chief Stephen Klasko and athenahealth CEO Jonathan Bush believe a healthcare system overhaul is not only necessary, but possible, and will talk about their ideas at HIMSS18 in Las Vegas.
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    The State of Indiana is moving to drop a lawsuit filed against more than 60 hospitals in the state that alleged they falsified records regarding release of electronic medical records and defrauded taxpayers of more than $300 million. 

    This latest development comes a week after CIOX Health launched its own suit against the U.S. Department of Health and Human Services claiming that the HHS enforcement of HIPAA is absurd and irrational. 

    [Also: CIOX Health sues HHS over 'absurd' and 'irrational' HIPAA enforcement]

    The two lawyers who originally filed the suit against CIOX Health aren’t fighting Indiana’ new move, as of now. Michael Misch and Bradley Colborn brought the suit in 2016 after they experienced trouble obtaining medical records from local hospitals. 

    Misch and Colborn tracked instances with several hospitals where they received electronic records starting in 2013, logging how many times they got the records within the prescribed three-business-day period and compared their findings to the hospitals' public reporting. The lawyers found discrepancies between their experiences and the hospitals’ reporting. 

    [Also: UPDATED: 62 Indiana hospitals named in $300 million fraud suit over EHR kickbacks]

    Hospitals tracked by the lawyers contracted the handling of their medical records requests to Georgia-based CIOX Health. The company has been named in the suit as having violated the federal Anti-Kickback Statute and state law for allegedly overbilling patients for their own medical records.

    According to court documents, the state has determined that further prosecution of the case is not in the public interest because of the resources it would require, both monetary and personnel, and filed a motion to dismiss.

    “The State anticipates that it will impose substantial burdens on both the State and the United States in the form of monitoring and participation in the proceedings as well as complying with anticipated discovery obligations. The State believes Relators’ claims have little, if any merit; therefore, it believes Medicaid will not recover anything in this matter,” the legal motion read.

    Indiana Public Media quoted a response from Misch and Colborn regarding the state’s filing. “While the [Plaintiffs] do not agree with the State of Indiana’s legal analysis of the claims raised in this matter, the [Plaintiffs] and the State, however, agree that the State is entitled to substantial deference in deciding what claims are prosecuted on its behalf,” they wrote in the response. “As a result, Plaintiffs have decided not to oppose the State’s motion.”

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

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    Indiana moves to drop hospital EHR lawsuit against CIOX Health
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    Indiana moves to drop hospital EHR lawsuit against CIOX Health
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    Motion filed states charges have little merit and the case will require too many resources with too little to gain.
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    Abundant data supports the premise that most healthcare breaches are caused by unauthorized access or disclosure, whether by negligence or malicious targeting.  Gartner recommends that healthcare organizations bring in a centralized, cloud-based identity and access management solution to protect access and usage of data.  This webinar will present a case study on a hospital system that is the largest Cerner deployment in the world and what they did to establish an access environment that enabled them to support and protect 37,000 employees, 22 hospitals and 185 clinics and urgent care centers.

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    Understanding and Reducing Healthcare Data Access Risks Through Identity and Access Management
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    Understanding and Reducing Healthcare Data Access Risks Through Identity and Access Management
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    Abundant data supports the premise that most healthcare breaches are caused by unauthorized access or disclosure, whether by negligence or malicious targeting. Gartner recommends that healthcare organizations bring in a centralized, cloud-based identity and access management solution to protect access and usage of data. This webinar will present a case study on a hospital system that is the largest Cerner deployment in the world and what they did to establish an access environment that enabled them to support and protect 37,000 employees, 22 hospitals and 185 clinics and urgent care centers.

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    Managed services organizations supply implementation and operational expertise to advance the capabilities of IT, both to relieve internal staffers of more mundane uptime duties and to supply the ready sophistication needed for specific applications and analyses. These companies have myriad combinations of technical and operational skill, and vendor selection can preordain the impact of managed services.

    IT in healthcare gets more complex and skill-dependent all the time. Care facilities both have to expertly implement new systems or upgrades and know how they can optimally serve clinical objectives. Outside assistance must be specific to healthcare, from clinical familiarity to cybersecurity idiosyncrasies, said Dawn Mitchell, an independent health IT consultant. “Be cautious with managed services providers that have been doing this in every other industry, recently moved into healthcare, and don’t have the internal expertise required to be successful,” she said.

    The services provider has to recognize healthcare demands such as responding very quickly when system problems put lives on the line, said Lee Kim, director of privacy and security at HIMSS. In managed services, critical shortcomings have a lower priority and are addressed belatedly or not at all, she said, adding, “You don’t want a dabbler in healthcare; you want someone with an established healthcare base.”

    Trusted partnership

    When Comanche County Medical Center needed to upgrade to the current priority pack of its EHR to meet meaningful-use requirements, it sought a managed services provider to do the implementation, add server capacity and manage operations, according to Ismelda Garza, CIO of the rural Texas critical-access hospital. The decision came down to expertise and a trusted partnership between the managed services provider and its EHR-specific hosting solution.

    The resulting close partnership with Comanche cannot be underestimated, according to Garza. “I generally see that other managed services are neither interested in becoming a true partner with my hospital nor ensuring we are successful,” she said. “Relationships are key.”

    The managed services firm should probe the customer to determine the best specific solution for the immediate term and then continually improve on it, Mitchell emphasized. “You really need to look for a partner, not a vendor,” she said. “It’s definitely not one-size-fits-all, and some vendors don’t have the flexibility required.”

    Expertise breadth and depth

    Expertise must be broad to effectively support hybrid IT environments and deep enough to meet the expectations of clinical and operational users, Mitchell said. Also, lack of depth in a level one service desk can delay problem resolution, increase the load for level two support, and frustrate physicians and other users who expect immediate resolution.

    Managed services staff should also be available to provide subject matter expertise and knowledge transfer to internal staff. “It’s a win-win when super-users can solve issues in the field, and they never have to call the help desk,” Mitchell said. End users get immediate resolutions and the number of service calls go down.

    Comanche’s managed service provider’s expertise is specialized ― teams for hardware, network, data backup and more ― which supplements the four-person IT staff at Comanche who “wear many hats,” Garza said. “Having our EHR system hosted allows my team to focus its priorities on other projects concerning patient care areas and other IT projects.”

    Solving problems at their roots

    All contracts should have service level agreements with metrics requiring quick problem resolution and nearly continuous uptime, as well as milestones for evaluating performance, but it’s just as important to categorize issues, address the root causes of recurring problems and fix them. “When your provider can identify that 20 percent of your calls during any given month come from a group of physicians who clearly need additional training, then you work together to make that change happen.” Mitchell said. “You reduce the number of calls, and your users are happy, more self-sufficient.”

    The services provider should have good reporting processes and tools to keep internal staff and users informed as to the status and estimated turnaround time-of-service requests. Long wait times and the lack of communication around them “are major dissatisfiers with service desks,” she said.

    Comanche’s services provider will “notify me of issues before I know of issues,” Garza said, and it keeps her continually informed through biweekly account rep calls, daily backup status updates and monthly reports on server availability. “It takes responsibility for issues or problems; it also works with [our EHR vendor] directly to resolve issues. All these things help contribute to my confidence in its ability.”

    Whether resolving a routine user access issue or planning to incorporate new breakthroughs in workflow automation, a managed services provider should always inspire such confidence, grounded in obvious know-how and the ability to put itself in the healthcare customer’s place.

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    San Francisco startup Innovaccer said it will announce a new alerting tool that integrates with EHRs at HIMSS18.

    The software, dubbed InAssist, is compatible with browser-based electronic health records platforms to make health data more transparent by employing algorithms that let clinicians know when a specific patient needs attention.  

    “Actionable insights like records found through multiple clinical systems, care gaps, CDI gaps, patient's previsit summary and other information is directly sent as a notification to EMR's web view without altering the EMR experience,” Innovaccer CEO Abhinav Shashank said.

    Shashank said pulling that data into an EHR is more effective than two-way interoperability because there are no additional workflows and clicks to access the information, meaning physicians do not have to navigate through multiple records to find out information for every visit.

    He added that the software can include more data, such as coding gaps, risk scores, markers, vitals, lab results, medications, recent visits and care teams. And InAssist can be integrated with additional software systems that support RESTful APIs.

    “Our goal is to support value-based reimbursements with a reduced physician burnout. On an average, 1 risk point equates to an $8,000 opportunity, and if CDI gaps are covered, these opportunities can be realized,” Shashank said. “Additionally, it improves quality as physicians close identified gaps in care.” 

    At HIMSS18, Innovaccer will be in Booth 12752 at the Venetian Sands Expo Center in Las Vegas.  

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

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    The decision to replace the U.S. Department of Defense’s outdated ALTHA was one embraced by officials and its clinicians, who often complained of disparate systems that couldn’t speak to each other. The tech was also far too expensive to maintain.

    DoD officials spent three years planning the replacement, and when the last of the four test sites went live in October at the Madigan Army Medical Center, everyone waited anxiously to see what would happen next.

    Officials have been relatively quiet on the project, outside of a few media calls in the fall that hailed current progress. But recent reports have said the silence is due to a pause while the agency handles the mass amount of user complaints.

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

    However, this lull period is no pause, nor was the assessment unplanned. In response to whether he could confirm recent reports the project was “paused,” DoD Defense Healthcare Management Systems’ Communications Director David Norley said, “Deny.”

    “No one has stopped using MHS Genesis,” Norley said. “We’re not slowing our efforts on MHS Genesis: We’re full steam ahead.”

    Planned assessment

    In order to address some of the concerns brought to light by users, project managers are looking at all four site configurations, Norley explained. Project officials are taking user feedback and adjusting workflows -- and in some cases adjusting software.

    Further, the team has focused its efforts on updating the configuration of the test sites, assessing the issues and tech in order to prepare for the next wave of deployment. Norley said that once the configuration is set up, the next wave of rollouts will continue.

    But this period of “lull” shouldn’t come as a shock. This assessment period was actually part of the original plan. In fact, the 8-week period is actually truncated from the original intent.

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

    “We always knew we were going to have to make adjustments to the system,” said Norley. Initially, the plan was to roll out all four sites within four months in Oct. 2016, and “then take 10 to 11 months for adjustments… But we shifted the schedule as it took a lot of time for those sites to get online.”

    In May, the assessment period will conclude and the program will go into a critical review -- the final stage explained Norley. Leadership at all four sites will get together to approve the pieces of the system that are functioning -- and those that aren’t.

    User complaints

    As for the reports on site of user unhappiness, Norley said he believes there’s been a “misunderstanding of what we’re actually doing.”

    The trouble is that some sites like Fairchild Air Force Base have been operating on the system for more than a year. Perhaps some users came in excited to work with the program, but found issues and reported it to the ticket system, he said. 

    Norley admitted that not all tickets have been resolved or responded to as DoD has received at least 17,000 user complaint tickets since the project launched last year. Officials have addressed 11,000. 

    [Also: Congress is trying to ensure interoperability between VA, DoD]

    “It’s not like there hasn’t been any action,” Norley said. “If there was a critical user concern, of course, we made the change.”

    The way the system is set up, the user dictates whether an issue reported is critical. Norley said the trouble is that while the user may find that issue critical, those in Washington, D.C. may not. 

    However, while those tickets may not have been responded to in the way the user intended, all issues will be addressed during the critical review period.

    “I can understand why that would be unfulfilling,” said Norley. “You’re trying to do business, and what you’re not getting is the feedback.”

    But a change at one site makes changes to the entire enterprise, so Norley stressed that those major changes are being included in the assessment period. Officials have taken consideration all workflows and where the platform would be at the end of the project.

    To Norley, it’s important now to make those adjustments to training and how the system is set up, in order for officials to sign off on the project -- and further the rollouts. The initial rollouts have all been part of a planned test phase for the EHR project, to make sure the agency gets it right.

    “We’re going to have some software changes. And there will be a release in the next few months that will address those changes,” said Norley. “And we’re going to take a look of how we trained and how we could do a better job to make better preparation for the next wave that happens.”

    “Did we get everything right? No. But it’s functioning,” he continued. “Once we get the configurations dialed in a little better, we can also provide feedback to those end users.”

    And Norley stressed part of those adjustments will likely be made on the ticket system to address those user concerns.

    “In the future, our issue evaluation process will be a lot smoother,” Norley said. “There are a lot of wickets to go through, and I think we’re coming up with how to be more agile on how we deal with those responses.”

    Interoperability with VA

    It’s crucial DoD gets it right. Congress has pressed the agency to improve its system -- and its interoperability with the Department of Veterans Affairs for years. Efforts to work together in the past have failed, but it seems both agencies have turned the page and are dedicated to creating an interoperable system for its 16-17 million constituents.

    But while VA Secretary David Shulkin, MD, has pushed back the timeline for signing its own Cerner EHR contract due to interoperability concerns, Norley stressed the VA’s decision has had no impact on the DoD project.

    While Shulkin is looking for the best system to work across the public and private sector, Norley said the DoD’s MHS Genesis has a unique configuration. The agency implemented a number of interoperability goals and for now the agencies share data with its legacy eHealth exchange.

    “Once the VA locks down its configuration, we’ll definitely be working with the VA to make sure Genesis is the most interoperable system in the U.S.,” said Norley. “Linking arms with the VA, that’s a strong voice for how those systems exchange information with the private sector and the government.”

    The next stage of MHS Genesis rollouts are planned for late spring in Southern California.

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

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    Healthcare systems with well-functioning electronic health record (EHR) systems often find that smaller hospitals and clinics in their service area are in no such shape, hard-pressed to afford and operate a top-shelf EHR that would immensely improve care and enable them to mesh digitally with larger referral systems. But there’s a way around this disconnect for both the IT haves and have-nots, to their mutual benefit.

    Organizations with EHR technical and operational acumen are extending their capabilities out to community or rural facilities through a program called provisioning. For example, UnityPoint Health, from its base in Des Moines, has connected its Epic EHR system to 18 hospitals and 62 clinics, while Providence St. Joseph Health, based in Renton, Washington, has provisioned 13 hospitals and 37 physician practices to date.

    For organizations seeking to expand their reach, provisioning is giving critical access and other resource-limited care facilities a reason to affiliate, said Brian Moreau, director of UnityPoint’s Community Connect unit, which packages the health system’s Epic EHR and related services for resale to others. Moreau called it “a big part of our growth strategy” and cited “a direct connection” between its success and “the growth of our community network of rural hospitals.” Several rural hospitals became affiliates specifically because they wanted to participate in the Epic Community Connect program, he said.

    Enhanced expertise, technology

    A dedicated team was set up to reorient everything from implementation to workflow around the needs of critical access hospitals. This has brought not only the particulars of EHR operation but also the evidence-based practices, quality improvement initiatives and analytics of a large system to rural providers via applications and tools that would be unaffordable for the small facilities that Epic does not target.

    “Sharing of best practices and elevating quality is the vision,” Moreau said, a vision that includes opportunities to network with other hospitals and to benefit from the more than 600 IT staff in UnityPoint’s employ, all working to improve access to data on patients shared by multiple providers and strengthening population health efforts. 

    Providence, also an Epic EHR user, bills the costs of licenses, third-party applications, the work of analysts and other services as a “pass-through” to affiliates, at no markup, to further the program’s affordability for largely rural, outlying facilities, said Sherry Maughan, vice president of the Community Connect program. The Providence St. Joseph program, which is accredited by Epic, has grown over the past several years and includes a breadth of services such as account management, operational support for contracting, invoicing and purchase order management.

    Physicians at affiliated rural practices and hospitals see the same record and user interface as clinicians working within the Providence St. Joseph Health organization, which includes Swedish Medical Center and Providence St. Joseph Health locations in western Washington and Kadlec Regional Medical Center in southeastern Washington and neighboring states. It makes for a seamless experience whether a patient is at a rural clinic or seeing a specialist in a Providence facility, said Rob Watilo, chief strategy officer for Providence St. Joseph Health, Southeast Washington service area.

    Seamless, efficient access

    When bringing provisioned doctors and hospitals into the existing Epic EHR system, from a patient clinical information standpoint, “it’s like that patient in the outlying community was seeing one of our primary care physicians or specialists ― it’s that seamless as far as access to information,” said Watilo.

    If a patient has to leave the community for additional care, it’s a much cleaner referral ― all medication lists, history and clinical information from the smaller hospital’s EHR are a touch away instead of scattered in faxes and scanned documents, he said. The family doctor can see specifics of what was done and any changes in medical picture after the patient returns home.

    Small hospitals gain information access and efficiencies in clinical care they could not have managed on their own, said Katie Heldt, chief nursing executive of Greene County Medical Center, a UnityPoint affiliate in Jefferson, Iowa. “We are very fortunate as a rural facility to have Epic as our electronic medical record; it helps us to be able to share patient information in a protected way, a consistent way that everybody understands.”

    At a Des Moines facility or an urgent care center, a doctor can seek a Greene County patient’s record and “it’s all right there,” Heldt said. “It saves time, it saves money, it’s efficient and reduces variability.” Best practices and standardization through Community Connect have improved outcomes in quality, which has bolstered clinician acceptance. Physicians still have the ability “to use their knowledge and think on their feet, but it does provide some guidelines for patient care, and it’s truly appreciated.”

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    eClinicalWorks CEO Girish Navani said the company will be focusing on three technological developments at HIMSS18.

    It’s been quite a year for the vendor since HIMSS17. In May it settled a False Claims lawsuit with the U.S. Department of Justice, which was followed by a $1 billion class-action suit in November and another class-action complaint in December, for which the specific amount remains to be determined.

    [Also: HIMSS18 Artificial Intelligence and Machine Learning for Healthcare event: Moving AI out of the dark]

    Along the way, however, the company won a string of new customers, including Digestive CARE saying in mid-January its 28 offices went live with eClinicalWorks, and released version 11 of its EHR – which Navani said customers have been deploying in January and February of 2018.

    And at HIMSS18, the company is focusing on “elevating an EHR from the traditional mindset of data entry to smartness and intelligence that helps doctors,” Navani said.

    Three examples that will be on display at the health IT conference are the Open and Connected Office, Virtual reality and precision medicine features and functionality within the EHR.

    eClinicalWorks EHR, specifically, can now integrate genetic screening and results into the order entry process, Navani said.

    “Not only do we have the ability to order that test as easily as doctors can order a blood test but going forward the lab will send the results back into the EHR,” Navani added. “At the point of entry the physician writes an order, like a medication, and it validates that against the genetic profile.”  

    On the artificial intelligence front, eClinicalWorks’ new iteration also includes Eva, a virtual reality assistant not altogether unlike Apple’s Siri. Clinicians say “Hello Eva,” and Eva responds with choices pertaining to tasks doctors typically do during an office visit, such as select a patient by name, send messages without interrupting the workflow, open a progress note, or ask Eva to add a new diagnosis to the problem list, among other operations.

    “Why cannot I ask the EHR to do things for me?” Navani said. “Or ask it questions? Or better yet have it just tell me what I should do?”  

    Navani said the Open and Connected Office features, which are underpinned by the company’s FHIR-based interoperability hub, will enable clinicians to visually see every health system they can now interoperate with by clicking on a menu item, then opting to connect so they can see how other doctors are treating a particular patient.

    “This is like the ATM network. But you don’t have to pay that $3 transaction fee,” Navani said, explaining that most Epic and many Cerner hospitals are already on this via Carequality’s end-users agreement that hospitals sign or the Commonwell Health Alliance, wherein patient level consent happens at check-in time.  

    “Interoperability will become a given and what we do with the information will be the next level of innovation,” Navani said.

    Speaking of next levels, Navani also gave a glimpse of where eClinicalWorks technology is headed post-HIMSS18.  

    “We’re getting into the acute care side by the middle of the year,” Navani said. “It’s not just the provider side, we’re doing the same thing for the patient side, telemedicine, a kiosk, messaging, all of the above.”

    Much like the way so many Enterprise Resource Planning companies once made giant software packages and that was all they sold but many have evolved into broader offerings, Navani said EHR vendor will become patient relationship management companies.

    “Machine learning is coming. You will see some real applicability,” Navani said. “Machine learning at least to help a doctor is going to be en vogue as third party companies build interesting models EHRs can include.”

    eClinicalWorks will be in Booths 145 and 11955 at HIMSS18 at the Venetian - Sands Expo Center in Las Vegas. HIMSS18 runs from March 5-9, 2018.

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

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    The Cerner EHR contract with the U.S. Department of Veterans Affairs is on hold pending an independent assessment of the agency’s interoperability requirements for the new EHR, said VA Secretary David Shulkin, MD, to the Senate Committee on Veterans Affairs on Wednesday.

    The “strategic pause” in negotiations between the EHR giant and the VA went into effect on Dec. 13 while MITRE performed an independent assessment of the national interoperability language laid out in the proposal request awarded to Cerner.

    [Also: VA, Cerner EHR deal held up after spat over interoperability definition, report says]

    The VA chose MITRE to assess contract language during a review held on Jan. 5. MITRE will submit a final report to Shulkin by the end of the month after the group of clinicians, chief clinical officers and executives pool recommendations and comments from that review.

    “My objective when it comes to healthcare for our veterans is to have a fully integrated, interoperable, operationally efficient healthcare system that’s easy for veterans, employees and community partners to navigate,” Shulkin told the committee.

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

    Reports surfaced at the beginning of the month that a meeting between Shulkin and Cerner executives was tense, with Shulkin saying: “To say it wasn't a good meeting would be an understatement."

    The issue was Cerner’s interoperability definition was too limited and covered only documents called CCDAs, or Consolidated Clinical Document Architecture.

    Interoperability is at the core of Shulkin’s EHR modernization plan, so agreement on terminology is crucial to the project moving forward. The VA Secretary has repeatedly expressed his commitment to selecting Cerner to replace the agency’s legacy VistA EHR.

    Initially, contract negotiations were expected to take up to six months, with Shulkin giving Congress a 30-day notice of award of contract in late September. The agency is well beyond that timeline, and these continued delays are concerning some lawmakers who feel it puts cost savings and efficiency at risk.

    The project is slated at upwards of $10 billion and could take about a decade.

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

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    James Hereford, president and CEO of Minneapolis-based Fairview Health Services, a not-for-profit integrated care system based in Minneapolis, called Epic Systems an "impediment to innovation.”

    “I will submit that one of the biggest impediments to innovation in health care is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform,” Hereford said during the panel discussion hosted by the Minneapolis-St. Paul Business Journal.

    Hereford, who called for a march on Madison, Wis., a city about 10 miles from Epic headquarters in Verona, Wis., also complained Epic had “architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin,” the paper reported Hereford as saying.

    He suggested that organizations get together and say to Epic, “Look, you have to open up this platform.”

    That would enable an ecosystem of innovation to benefit everyone who is cared for by clinicians using Epic, he added.

    It’s not the first time Epic has been accused of operating a closed system – one that does not interoperate with other EHRs.

    Epic spokesperson Meghan Roh countered that Epic’s system is open and third-parties are putting it to use.

    “We are excited about the hundreds who have joined our developer program, as well as the many whose innovations are now available on the App Orchard,” Roh said.

    The App Orchard is an online store that enables software developers to sell their Epic-compatible apps.

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

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    Mike Restuccia says surprising partnerships -- CVS and Aetna for instance -- will generate new requirements and adjustments that change the landscape.

    At times, many of us wish there were a crystal ball to easily show us what lies ahead in the fast-paced, ever-evolving world of health IT.  Just two years ago, January 2016, I offered my own insights through a blog post projecting what would lie ahead for that year.  

    I looked back with curiosity on those projections and pleasantly confirmed that generally “I was on-track”.  My 2016 forecast covered these topics:

    1. Ongoing industry consolidation 
    2. Shifting of EMR focus from implementation to optimization
    3. CIO leadership challenges

    After two years, I think it’s difficult to see each trend continue exactly as originally predicted.  I think it is fair to say that the predictions from 2016 will continue to be trends for the future and that there will be additional trends developing.  

    With history on my side, here are the additional upcoming trends (for the next 24 months) that I foresee. 

    1. Cyber Everywhere – It seems that not a day goes by without another organization reporting the loss of data.  This situation continues where not only are the bad-actors getting smarter, faster, but individuals in which they prey seem to be getting less adept; which is frightening.  Despite the best efforts of organizations to introduce education and technology to protect the data, many individuals continue to struggle in their own diligence surrounding cyber; often giving up their credentials to unscrupulous individuals and sharing private / confidential data on public networks. Look for much more draconian measures to be introduced along with more personal accountability associated with protecting data.
    2.  Analytics, Analytics and Analytics Interestingly the trend will be less about getting data out of the source systems or data mart, but more focused upon the operations personnel using the data in order to make substantive decisions and improvements within their organization.  This will require strong collaboration between representatives of information services and their operational counterparts in order to gain consensus on an enterprise data model and data definitions.
    3. Service Orientation – With many organizations at the tail end of their electronic medical records implementations and industry statistics indicating that most organizations use about fifty percent (50%) of the application’s functionality, there is a significant opportunity for a redefined IS service approach that is much more proactive and personalized than simply reactive.
    4. Shift to Outpatient Care Settings – Reimbursement and risk bearing care arrangements will continue to drive patient care to the home and outpatient settings.  Support of the medical home and particularly telemedicine and acquiring patient-reported outcomes will serve as strategic differentiators for healthcare organizations.
    5. Partner Innovation – For those with a stable EMR platform, the opportunity to drive significant value from their EMR through a variety of innovative technologies and partnerships has never been greater. Recent announcements between Apple and Stanford Medicine in which irregular heart rhythms are identified as part of a research study via the iWatch and a health system clinical command center is just the tip of the iceberg as organizations like Apple, Google, Amazon and others look to improve global health.

    I’m interested to see what the next two years bring in terms of how this year’s projections work out. The healthcare environment continues to change rapidly.  

    Surprising partnerships— CVS and Aetna for instance — will generate new requirements and adjustments that change the landscape even further. As the past several years have displayed, the healthcare environment is one of consistent change and an exciting field to be a part of in innovating and shaping the future.

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    For health IT consultant Janae Sharp, this year’s presentation at HIMSS18 will be her first. And it’s personal. Sharp’s husband John was a physician until two years ago when he committed suicide. Now Sharp is on a mission to educate providers, systems and the industry as a whole that physician burnout and suicide is a problem that cannot be ignored any longer. And there’s even a role for data and your EHR to play in tracking employee behavior and potential risk for suicide.

    But it’s a difficult conversation to start. The stigma carried by suicide deaths is real, Sharp said, and even affects how physician suicide is measured. The only notable measures are burnout and screening for depression.

    “They don’t really want to talk about it and there’s still a lot of shame surrounding it,” Sharp said. “Typically if someone died by suicide, a normal employer would have some kind of crisis response. In school settings that’s legislated. In healthcare, it’s not legislated. Medical education doesn’t legislate it.

    [Also: Solving physician burnout: Interdependent care teams beyond hospital setting could be answer]

    An estimated 300-400 physicians die by suicide in the U.S. every year, according to the American Foundation for Suicide Prevention, and 28 percent of residents experience a major depressive episode during training versus 7-8 percent of similarly-aged individuals in the general U.S. population.

    During her HIMSS18 presentation, “Physician Suicide and Clinician Engagement Tools,” Sharp will share more of her personal story, as well as shed a much-needed light on the issue including its social aspects, burnout measures, historical and suicide trends among doctors and contributing behavioral health factors and coping skills. Sharp’s goal is to personalize the issue and provide a space for people to deal with it, to create a space for the conversation to start happening.

    “There are insurance repercussions and less people help you because they don’t know how to approach it because of the stigma,” Sharp said. “That stigma also has direct financial implications on survivors.”

    For such a complicated issue, there must be a multi-pronged solution. It’s not as easy as providing a yoga class for your residents. Health systems should have a behavioral support system for providers, for starters. 

    “It’s important for hospitals to quantify the problem for themselves,” Sharp said. “And then to have a planned approach for crisis solutions and for actively teaching your staff how to deal with mental illness or acute trauma for a caregiver.”

    Janae Sharp’s session, “Physician Suicide and Clinician Engagement Tools,” takes place on Thursday, March 8th at the Venetian Convention Center, Palazzo L at 4 pm.

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

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    Physician suicide: A survivor’s story of empowerment
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    EHRs, analytics can help track doctor burnout and potential suicide risk
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    HIMSS18 presenter and Health IT consultant Janae Sharp lost her husband to suicide and now believes clinician engagement tools can help doctors in the future.
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    A limited number of Allscripts services went down Thursday after a ransomware incident, according to an emailed statement from company spokeswoman Concetta Rasiarmos.

    The EHR giant is investigating the incident to provide further details.

    “We are working diligently to restore these systems, and most importantly, to ensure our clients’ data is protected,” wrote Rasiarmos. “We regret any inconvenience caused by this temporary outage.”

    Users took to Twitter yesterday to express frustration with the outage. One specifically referred to downed cloud services, being unable to access patient data all day. Allscripts directed users to its support team for more information.

    The Allscripts website and Twitter account don’t specifically mention the outage. Instead, the company tweeted to users who specifically took to the social media account to voice concerns.

    Rasiarmos said, “There is currently no evidence that any data has been removed from our systems.” This story will be updated as more information becomes available.

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

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    Innovation is something everyone in healthcare is after. But not everyone is approaching it the same way – and not everyone is able to prioritize it in the ways they'd prefer. That's according to a new survey of CHIME member CIOs from Impact Advisors.

    The poll finds significant divergence across health systems with regard to innovation efforts, and an uneven pace of change as certain IT leaders are freer to innovate than others, with the budgets, staff resources and leadership support to put technology to work in envelope-pushing ways.

    [Also: 2017: The year interoperability innovation grew legs in the private sector]

    When it comes to emerging technologies set to make their mark on healthcare, HL7's FHIR specification was seen as the one with the most potential to have an impact in the next two years, while blockchain was seen as the most overhyped.

    Some 14 percent of CIOs said their organization has launched a dedicated IT Innovation Center.

    Twenty-five percent said their health system has formed a partnership focused on innovation with a healthcare IT startup; 16 percent cited a partnership with an IT vendor from outside of healthcare. Forty-three percent say they plan to launch new strategic partnerships focused on innovation, in the next two years, while 36 percent plan to create more structure internally innovation. 

    [Also: Innovation: It’s about survival now]

    More than a third, however, say they have virtually no plans at all to drive IT innovation in their organizations over the next 24 months.

    CIOs' opinions of emerging technologies are especially interesting to note and offer some useful on-the-ground insights in an industry with no shortage of marketing hype.

    FHIR and APIs were overwhelmingly seen as the tech with the most transformative potential over the next two years (50 percent of respondents), followed much further down the list by natural language processing (16.1 percent), cloud computing (14.3 percent) and machine learning (12.5 percent). Only 1.8 percent of CIOs surveyed cited blockchain as their top choice, with 48.2 percent listing it as the "most overhyped."

    Among other highlights from the report, Impact Advisors found that "formalized IT innovation efforts at surveyed provider organizations are still largely in the early stages, with limited structure currently in place," according to researchers. Just one-third of the CIOs surveyed said their health system has an internal committee or working group that meets regularly about innovation; just one in five said their organization has a  defined portion of its IT budget earmarked specifically for innovation.

    The CHIME members surveyed were asked which area of  IT  innovation was their highest priority: The majority (nearly half) said "increasing internal operational efficiencies."

    On the other hand, among those who reported having the most structure in place around IT innovation – those with dedicated innovation centers, especially – that priority was the least common response. Instead, half of the most advanced CIOs said enhancing patient experience was their top priority, while another 25 percent cited "driving knowledge and discovery," according to the report.

    Among the barriers to IT  innovation, the most common was "other priorities are currently more important," according to 68 percent of the CIOs polled, followed by "resource capacity" (59 percent) and "funding" (55 percent).  

    Meanwhile, "only 25 percent of CIOs cited 'lack of governance/structure to support innovation' as a significant barrier, perhaps underscoring the fact that many formalized IT innovation efforts have yet to really even get started," according to the report.

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

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