Veterans Affairs Secretary David Shulkin, MD, proposed a revision to federal regulation on the confidentiality of medical records to fuel better data sharing with private sector providers.

The rule proposes changing VA privacy regulations by letting agency providers release patient medical records to eligible community providers, even if a physical copy of the patient’s written consent is not present.

The change would instead put the burden of attesting patient consent on health information exchange providers.

[Also: Shulkin: VA-Cerner EHR deal paused over interoperability concerns]

“This proposed rule would be a reinterpretation of an existing, longstanding regulation and is necessary to facilitate modern requirements for the sharing of patient records with community healthcare providers, health plans, governmental agencies and other entities participating in electronic HIEs,” according to the rule proposal.

The hope is the change would improve veteran care at community healthcare and HIE providers by opening up access to patient data at the point of care, the rule summary explained.

The proposal won’t infringe on a veteran’s privacy rights, as “such disclosure would still require a legally sufficient written consent.” The only proposed change is to expand the ability of outside providers to obtain consent to share records.

Further, the written attestation wouldn’t require a physical document and signature. An electronic attestation would suffice.The agency feels the majority of attestations would be done electronically through approved messaging with HIE providers.

The community provider would be able to either make the consent form available to the VA within 10 days of attestation or maintain the patient’s written consent form with a memorandum of understanding, drafted and signed by the VA and community partner.

If approved, the change will continue Shulkin’s quest for open interoperability within the VA and outside private sector partners. Currently, the agency put its planned EHR contract with Cerner on hold over interoperability concerns.

The proposal is currently in a comment period, which will close on March 20.

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

Allscripts is still attempting to get all services back to normal after its Raleigh and Charlotte data centers fell victim to a ransomware attack late Thursday night. While waiting for the electronic health record vendor to straighten the situation out, customers are experiencing outages.

“Ransomware attack on Allscripts has taken down our e-prescribing, EPCS and some other services,” Yvette Crabtree, MD, a Kansas CIty-based physicians affiliated with Sunflower Medical Group said. “At least we don’t use their hosted application. I hear many hosted practices couldn’t access their EMR yesterday.” 

[Also: Allscripts hit by ransomware, knocking some services offline]

After learning about the attack from Allscripts on Thursday, Northwell Health in New York took the precautionary measure of disconnecting from Allscripts data centers, according to a Northwell spokesperson. 

“Northwell moved quickly to avoid the potential for complications and Allscripts does not believe any data from its system was removed,” the spokesperson said. “The electronic prescribing of controlled substances was the only electronic medical record that was unavailable to providers at Northwell Health’s facilities – we have 23 hospitals and about 660 ambulatory locations. Northwell resumed normal operations over the weekend.” 

So far, there’s no update on the Allscripts’ website or social media accounts about the outage -- or how long it’s expected to get all sites back online. 

The company hasn’t commented on how many providers were impacted by the outage either, but Allscripts supports over 180,000 physicians, 100,000 electronic prescribing physicians and about 40,000 in-home clinicians. 

In the meantime, Crabtree said the in addition to the EPCS being down for three days, making eprescribing iffy, services that relied on Allscripts data center were also down. 

“We still had our EMR because we have our own server,” she added. “From what I can tell we were lucky. It’s the clients that have cloud hosted services who were really screwed."

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

More and more hospitals are undertaking initiatives to improve day to day operations, workflow and working conditions for clinicians. The concept has been pulled into the Quadruple Aim, which builds on the Triple Aim of improved patient care for a healthier population at lower costs by adding physician satisfaction. 

The University of Missouri Health Care is one example of a provider that has put processes in place to make physicians enjoy their working lives more. 

The academic health system in Columbia, Missouri, employs a combination of weekly rounding, annual surveys, research, funded physicians and clinician-led governance to accomplish a wide array of goals the organization sets -- including boosting doctor’s satisfaction with the electronic health record software. 

MU Health Care’s latest annual survey, in fact, showed a 10 percent increase in overall satisfaction. 

“We engage on a personal level by assuring our IT staff make regular rounds at all clinical sites to hear first-hand the issues our users are having and often correct or mitigate on-site,” said Thomas Selva, MD, Chief Medical Information Officer. As he sees it, these "eye-to-eye" relationships make sure users know how important it is to provide an excellent experience with the EMR.  

Selva and CIO Bryan Bliven started by handpicking individuals to sit on the council based on their passion for IT, willingness to serve as well as their sphere of influence with other professionals.  

“We have shared governance with the EMR by purchasing physician time to assist in decision-making and at-the-elbow education of providers,” Selva said. “We purchase 10 percent of their time and ask them to not only educate their peers but also stress-test new code as we receive it.”  

Also, the council members serve as a team to validate whether new development locally is worth the investment. The health system uses the annual satisfaction surveys “to hear the voice of the customer” and build action plans around feedback, Selva said. 

The survey also helps executives identify areas of focus over the coming year.

Next up, for instance, Selva anticipates moving toward using new workflow and documentation tools that he expects will significantly improve physician and nursing quality of life. Also, the health system plans to move its Cerner HealtheIntent platform further into its population health strategy. 

At HIMSS18, Selva and Bliven will discuss more of their results during the session, “A Multi-Pronged Approach to Improve Provider Satisfaction,” on March 7 in the Venetian - Sands Expo Center Murano 3304.

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

After many months of rumors, Apple announced that it is launching a personal health record (PHR) feature with iOS 11.3, the beta of which launched Wednesday to users in Apple's iOS Developer Program. The feature, called Health Records, will aggregate existing patient-generated data in the Health app with data from a user's electronic medical record — if the user is a patient at a participating hospital. At launch, Apple is working with 12 hospitals across the country, including Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.

“Our goal is to help consumers live a better day," Apple COO Jeff Williams said in a statement. "We’ve worked closely with the health community to create an experience everyone has wanted for years — to view medical records easily and securely right on your iPhone. By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.”

[Also: FDA announces pre-certification pilot program for Apple, Fitbit, Samsung, Verily and others]

The feature will use HL7's FHIR (Fast Healthcare Interoperability Resources) specification. Users will be able to see things like allergies, medications, conditions, and immunizations, as well as the sort of things they might check an EHR patient portal for, such as lab results. They can be notified when the hospital updates their data. The data will be encrypted, and users will need to enter a password to view it.

Many of the hospitals participating at launch have a history of digital health innovation. Cedars-Sinai in Los Angeles, for instance, has been a major user of Apple products for some time — the hospital distributes iPads to patients for entertainment and communications purposes, and has a comprehensive patient app for the phone and the Apple Watch.

"Putting the patient at the center of their care by enabling them to direct and control their own health records has been a focus for us at Cedars-Sinai for some time," Cedars-Sinai Chief Information Officer Darren Dworkin said in a statement. "We are thrilled to see Apple taking the lead in this space by enabling access for consumers to their medical information on their iPhones. Apple is uniquely positioned to help scale adoption because they have both a secure and trusted platform and have adopted the latest industry open standards at a time when the industry is well positioned to respond.”

The complete list of participating hospitals is: Johns Hopkins Medicine; Cedars-Sinai; Penn Medicine; Geisinger Health System in Danville, Pennsylvania; UC San Diego Health; UNC Health Care in Chapel Hill, North Carolina; Rush University Medical Center in Chicago; Dignity Health, a multistate health system covering parts of Arizona, California, and Nevada; Louisiana's Ochsner Health System; MedStar Health in the Washington, DC metro area; OhioHealth in Columbus; and the Cerner Healthe Clinic in Kansas City, Missouri.

Notably absent from the list are Duke University and Stanford University, which have been hospital partners for a number of launches in the past and from which Apple has made high profile hires — Dr. Ricky Bloomfield from Duke and Dr. Sumbul Desai from Stanford. However, Apple says additional health systems are set to sign on in the coming months.

[Also: Timeline: How Apple pieced together its healthcare plan]

News of Apple somehow entering into the EHR or PHR business did not come as a total surprise to the industry. Apple acquired Gliimpse, a small health data startup, in August 2016. Gliimpse was working on a PHR that skirted HIPAA difficulties by having the patient control their own health data. The main innovation of the product was an AI engine that reads medical records (with patients' permission, accessing them via the patient portal) and breaks down and codes them into a standardized and readable language. In retrospect, it seems very likely Apple acquired that technology and talent in order to develop this feature. Gliimpse CEO and founder Anil Sethi left Apple last year after serving in the role of director of health technologies, according to his LinkedIn page.

Additionally, CNBC reported in June of last year that Apple was working with startup Health Gorilla, which specializes in aggregating diagnostic information such as bloodwork. 

PHRs have a long and storied history in digital health — in addition to countless startups, both Google and Microsoft have attempted to create viable PHRs. Google Health's failure in 2011 was much-discussed and Microsoft's HealthVault, while still around, has never managed to obtain widespread adoption or move the needle on interoperability. Nonetheless, many thought leaders, including former National Coordinator for Health IT Dr. David Brailer, see a move toward patient-centered health records as either inevitable or necessary.

Apple has advantages no other company has ever had in this space. The company's long-term approach, introducing HealthKit, ResearchKit, and CareKit gradually, as well as its ubiquity in the United States, give it a real shot at making a patient-centered health record work.

Correction: A previous version of this article said that Gliimpse founder Anil Sethi was still at Apple. In fact, he left the company last year.

Twitter: @JonahComstock
Email the writer: jonah.comstock@himssmedia.com

There’s big money at play in health IT. So it follows that technology vendors and often spend their share on lobbying Congress, too. 

We checked OpenSecrets.org to see how much EHR makers allocated to lobbying the government last year and here's what we found.  

Allscripts: $140,400, the same as 2016
Athenahealth: $550,000, down from $600,000 in 2016
Cerner: $290,000, up from $200,000 in 2016
Epic Systems: $108,000, down from $144,000 in 2016
McKesson: $1,012,000, down from 1,235,000 in 2016

The numbers for 2017 show most EHR makers trimmed their lobbying spending compared to 2016. Allscripts remained the same, while Cerner is a notable exception for upping its efforts by $90,000 more than in 2016. 

OpenSecrets listed Cerner’s lobbying issues as defense, health, Veterans Affairs, federal budget & appropriations and government issues. 

Cerner, of course, won the massive Defense Department EHR modernization contract, worth an estimated $4.3 billion, in July of 2015. And though the ink is not yet dry on a similar contract with Veterans Affairs, VA Secretary David Shulkin, MD, said last June that the agency would also implement Cerner’s EHR.

[Also: How Cerner won the biggest EHR deal ever, twice]

2017 proved to be a year of achievement as well as challenges for health IT vendors. Epic was focused on healthcare reform, monitoring long-term care issues, prescription drug abuse and two new versions of EHRs. An activist investor took a stake in athenahealth sparking takeover rumors. Allscripts CEO Paul Black declared the company would “pull ahead of the pack” after acquiring McKesson’s health IT business.

OpenSecrets does not include information about eClinicalWorks or Meditech lobbying expenditures for 2017.

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

In the latest example of hospitals building new and innovative ways to share information, Novant Health and Wake Forest Baptist Health, both with Epic EHRs, are merging their healthcare data.

In the collaboration, called “Happy Together,” patients can now access their health information from both health systems in a single view via the Epic MyChart patient portal.

“The goal is to improve patients’ understanding of medications, lab results, plan of care and follow-up appointments,” Keith Griffin, MD, chief medical informatics officer at Novant Health, said in a statement.

[Also: UC Health goes live on shared, cloud-based Epic EHR]

Until now the two health systems maintained separate MyChart accounts for each of the two organizations. But now patients have access to their health information in a single account.

About 6,700 Novant Health patients had already connected their accounts on Jan. 17 when the project went live.

With the initial launch, patients have access to information between Novant Health and Wake Forest Baptist Health. Novant plans to expand the program to more health organizations that use an Epic EHR in the future. 

Last November, the University of California San Diego Health and UC Irvine Health struck an interesting arrangement wherein they rolled out a single cloud-based instance of Epic. 

Sharing the platform between two academic medical centers means clinicians from multiple sites will have access to medical records, and also generates efficiencies and shared services. 

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

Just one week after some of Allscripts’ services were shut down by ransomware, the EHR giant is facing a lawsuit for allegedly failing to secure its systems and data from cyberattacks.

Allscripts went down on Jan. 18, after two of its data centers in Raleigh and Charlotte, North Carolina fell victim to SamSam ransomware. The EHR vendor just yesterday got most services back online.

Boynton, Beach, Florida-based Surfside Non-Surgical Orthopedics is suing Allscripts on behalf of all clients impacted, as the system outage resulted in canceled appointments, care disruptions and "significant business interruption and disruption and lost revenues.”

[Update: Most Allscripts clients back online, but issues plague some cloud-based providers]

The provider was unable to access its patient records or electronically prescribe medications, and as a result of the outage, Surfside has “expended significant time and effort resolving these issues resulting from the breach.”

Surfside alleges that Allscripts was aware of “deficiencies in its products and services [that] could result in privacy and security vulnerability or compromises and failed to take adequate measures to protect against any such event.”

I work for a one physician office and we are at a stand still. Our practice mainly handles the elderly population who doesn't understand our reasoning for not being able to make appointments. We are unable to post charges. How does #Allscripts expect to get paid when we don't?

— Dawn Marie Ingram (@thrdmathis) January 22, 2018

The provider argued that as SamSam ransomware has been a known threat since 2016, the company should have audited or monitored its systems to prevent the attack. And its failure to do so caused the crippling system outage.

“Allscripts wanton, willful, and reckless disregard caused a complete and total interruption of service,” the suit reads. “Allscripts failed to implement appropriate processes that could have prevented or minimized the effects of the SamSam ransomware attack.”

Surfside claimed it acted in “reasonable reliance” on Allscripts’ “misrepresentation and omissions” about its security products. And said that had they known about the company’s lack of necessary precautions, they would never have purchased Allscripts’ EHR.

[Also: What to know about the SamSam ransomware hitting Allscripts, hospitals]

Given the long list of frustrated small practice providers taking to Twitter to voice those concerns, the lawsuit is not surprising.

Sultan Rahaman, MD, the owner Family Medicine Solutions in Longwood, Florida, said that he felt Allscripts had a history of being more “reactive than proactive.”

Reached on Friday, Allscripts Spokesperson Concetta Rasiarmos said Allscripts does not discuss pending litigation.

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

Allscripts has restored service to the majority of clients impacted by the outage caused by a ransomware attack on two of the company’s North Carolina data centers, company spokesperson Concetta Rasiarmos wrote in an emailed statement.

“We recognize this has been disruptive for our clients and are working around the clock to safely and securely return service to all affected clients,” said Rasiarmos. “We continue to work with the remaining clients to bring them back online as quickly as possible.”

[Also: Allscripts sued over ransomware attack, accused of 'wanton' disregard]

The EHR vendor went down after SamSam ransomware got into the company’s data centers on Jan. 18, which caused service outages to roughly 1,500 of its clients. After some services were offline for seven days, the company was able to get the majority of services back online on Thursday.

However, some physician offices brought back online are still experiencing slow access and login errors, according to Sultan Rahaman, MD, the owner of Family Medicine Solutions in Longwood, Florida, and a few Twitter users who reached out to Healthcare IT News.

"I’ve been very disappointed with Allscripts: It seems trite to paint a rosier picture when that’s not really the case."

Sultan Rahaman, MD

Rahaman said that while his EHR is back online, it still takes multiple attempts to log into the system.

“The login process is a little tricky,” Rahaman said. “We get an error message, close it, and try again. It takes about four or five times just to log-on.”

Rahaman’s four-employee practice runs on Allscripts’ Professional EHR PM. His struggle mirrors that of other providers, who have aired their frustrations on Allscripts’ customer message board and on Twitter.

We are a single physician practice as well, and he has scheduled surgeries on Thursday. This has made me so grateful for his tendency to hoard notes; without them we would be in serious trouble! #Allscripts has all but crippled us.

— TwinterIsComing (@GinaMCann) January 23, 2018

@jessiefdavis
To say some services have been lost at Allscripts would be an understatement approx. 1500 provider offices still don't have access

— debra (@bowdeb) January 24, 2018

Ohio-based Union Physician Services is one of the larger organizations to still be experiencing outages. While Union Hospital wasn’t impacted by the outage, nearly all of its physician offices are still dealing with operation disruptions.

Those Union providers impacted by the attack have limited access to patient medical records and those offices had to cancel and reschedule appointments. However, officials said they are still providing services for immediate medical care.

Union has not been provided a timeline of when services will be fully restored, according to the release. The provider has been running on downtime procedures since the outage. Union declined to comment further than the official statement.

[Also: What to know about the SamSam ransomware hitting Allscripts, hospitals]

But technology issues aside, some providers aren’t happy with how Allscripts is handling the situation.

While Rahaman said he can’t speak to whether the company could have prevented the attack, the fact services were down for seven days points to issues with preparedness and responsiveness.

“This builds onto a long track record of Allscripts history as being reactive and not proactive,” said Rahaman. “I’ve been very disappointed with Allscripts: It seems trite to paint a rosier picture when that’s not really the case.”

Specifically, Rahaman pointed to a few major issues with the company’s response. For example, while daily calls were held for customers since the attack, a legal spokesperson held the call and not a technology leader who could speak to challenges and timelines.

Further, Rahaman said it seemed like the calls repeated the same phrase every day, without many tangible details.

Other clients have taken to the company’s message board to air the same grievances, said Rahaman. “People across the client base are very shocked, very disappointed that their response was not better.”

And the unhappy providers aren’t alone: Boynton, Beach, Florida-based Surfside Non-Surgical Orthopedics filed a lawsuit against Allscripts yesterday on behalf of all clients impacted by the system outage.

The providers cite "significant business interruption and disruption and lost revenues” due to Allscripts allegedly failing to secure and audit its system to prevent the breach.

Allscripts declined to comment on the pending litigation. This story will be updated if more information becomes available.

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

Nothing stirs up social media more than a move by a major tech player in the healthcare space. The responses range from, “Finally, our hope has arrived!” to “Zzzzzzz, we’ve seen this before.”

Both are well-reasoned responses, of course. Tech players do have a tendency to change the status quo; they also conduct a crazy number of pilots, which adds to their institutional experience but doesn’t change much in the end.

[Also: Apple to launch Health Records app with HL7's FHIR specifications at 12 hospitals]

Apple is the latest tech player jumping into healthcare. They bring with them hopes of empowering the consumer, by providing them access to more of their health record. You can read about it from any of a number of sources, but let’s explore the fundamentals of this announcement.

What apple wants to do

Here are the details of this announcement:

Apple Health Records
Apple will use the FHIR specification to move data from the EHR to your phone. They will start with allergies, medications, conditions, immunizations, and lab results. This extension of iOS will support notifications from participating health systems when data is updated in their EHR. The data will be encrypted and utilize the normal Apple mechanisms for access.

Participating hospitals include:

• Johns Hopkins Medicine – Baltimore, Maryland
• Cedars-Sinai – Los Angeles, California
• Penn Medicine – Philadelphia, Pennsylvania
• Geisinger Health System – Danville, Pennsylvania
• UC San Diego Health – San Diego, California
• UNC Health Care – Chapel Hill, North Carolina
• Rush University Medical Center – Chicago, Illinois
• Dignity Health – Arizona, California and Nevada
• Ochsner Health System – Jefferson Parish, Louisiana
• MedStar Health – Washington, D.C., Maryland and Virginia
• OhioHealth – Columbus, Ohio
• Cerner Healthe Clinic – Kansas City, Missouri

Why this could be a big deal

There are a number of reasons that this move could have huge impacts across the healthcare space.

1. Ecosystem/Platform for Innovation
2. Reducing burden on Internal IT
3. Empower the patient
4. Timing
5. It’s Apple

Platforms, or ecosystems, usually precede big movements in an industry. iTunes launched Apple’s resurgence, a platform for music and eventually movies, games, and other things. Airbnb, Uber, Google, and others enable new models for age-old services.

This might be the start of such a movement. If Apple is able to grab enough clean and relevant data and place it into their ecosystem, you could see a plethora of new and innovative applications emerge. Apple already has an app store, APIs, SDKs, tools, and education around their platform.

EHR vendors are new to this platform game and will never have the reach that Apple has. The potential for creating new models is great.

Internal IT teams have been building, or buying, mediocre patient portals for a while now. Let’s hope that Apple can make it easier for health system staff to focus on the user experience. In turn, they can spend less time trying to get the data right.

I’ve argued for years that the patient is the only constant at the point of care. I may see a doctor in my home state or I may see a doctor while I’m on the road in another state; either way, I am the constant. If I had a way to direct and control my patient record in support of my own care, that would be a significant improvement in experience and potential outcome.

I believe that a truly portable health record and cost transparency have the greatest potential as agents of change in healthcare. This announcement is a foundation for portability.

The timing may be right for this announcement, as well. The combination of operational cost pressures on IT and the changing consumer buying patterns for healthcare have solidified the need for more cost-effective, consumer-friendly applications to serve our communities. If Apple is able to provide an easier path to a high-quality solution, they will find a receptive audience.

Of course, no list is complete without stating the obvious: this is Apple. The only announcement which could have garnered more coverage would have been a Tesla play in healthcare. Apple has the brand cache, an install base of over 1B iPhones, and around $270B in cash reserves to make something happen. This will trigger meetings in Madison and Kansas City.

Why it might not be a big deal

Conversely, there are a number of reasons why this announcement might not lead to much at all.

1. Hype leads to unmet expectations
2. The EHR vendors
3. Not ambitious enough.
4. Too long between iterations
5. EHR Workflow

This is not an EHR, nor is it a precursor to Apple getting jumping into the EHR market. Those who think this is going to solve usability challenges in the EHR are not looking at this correctly.

This move is clearly aimed at the consumer. All but the most innovative physicians will likely look at this with a healthy dose of skepticism. The hype will only make this problem worse. There is great potential here but it wasn’t designed to solve every problem facing the EHR.

The EHR vendor has no incentive or pressing need to open up the data to outside vendors… and that includes Apple. This is a dangerous position for the EHR vendors to take, but still, one they have taken in the past and one they will likely continue to take.

Yes, they are open platforms by their definition of “open.” EHR providers hold a lot of the cards and the data is a significant part of their value. Don’t expect them to give it up easily.

I’m afraid that Apple will take too long between the release of this solution and the next. They may not be ambitious enough in their plans.

A few well-placed moves and they could become the defacto platform for getting information to the emerging consumer patient. If they move too slowly, I’m afraid we will put this announcement on the stack of stories of how tech companies can’t figure out healthcare.

Finally, many applications require integration back into the clinical workflow, in order to provide value. This challenge can only be solved with deep integration into the EHR, which this solution doesn’t offer in its first iteration.

It may get there over time, but it doesn’t offer that today. This can lead to unmet expectations and an overblown hype cycle, as I mentioned in the first point of this section.

What Apple should do next

I’ve already written about this in a previous article, entitled From a CIO: What Should Be Apple’s Next Big Healthcare Move?

I’ll give you the punchline here: Digitize the intake process. Make it easy to collect basic questions from the patient with a mechanism similar to Apple Pay. Then, take it a step further and provide a way to send a basic set of questions to the patient around their procedure, storing that for easy sharing during their care journey.

With their market penetration, Apple is well-positioned to be a conduit for the consumer as they journey between disparate systems and the disconnected islands of information that, unfortunately, are a hallmark of healthcare.

Put me in the category of a hopeful optimist on this announcement.

Bill Russell is the CEO of Health Lyrics.

Dermatology is finding Fast Healthcare Interoperability Resources an increasingly useful standard from HL7.

CoxHealth, a Springfield, Missouri-based health system, is using the VisualDx app that uses medical images, visualization and machine learning to help compare variations of disease to get to a more accurate diagnosis.

[Also: Apple to launch Health Records app with HL7's FHIR specifications at 12 hospitals]

VisualDx is what's called a SMART on FHIR app. It is integrated into the health system's Cerner electronic health records system. Having the application integrated into the EHR saves physicians time by having it available at the bedside or with a patient in an examination room and linked to patient data.

"I primarily use the app when I'm outside of the office or not with a patient in the room," explained Louis Krenn, MD, chief medical information officer at CoxHealth. "I use it to create a differential diagnosis and then narrow the differential down. After that I review the possible conditions and details about those conditions.

"Being a SMART on FHIR app also allows it to be contextually aware regarding the patient and details about the patient including age, sex, medications and problems," he explained. "That helps narrow the differential faster. The FHIR app also allows you to click on any medication or problem and immediately start a differential search or obtain information about that medication or problem."

[Also: FHIR transformative, blockchain overhyped, CIOs say]

Having the EHR integration saves time by allowing physicians to start searching for information faster since it's already integrated into the record.

"I don't have to find another web site, pull out my smartphone, or leave the room to find information I need to care for the patient," Krenn said. "By having a quick, point-of-care reference tool that can be used from within the room, quickly, providers are more likely to use it, improving patient care."

CoxHealth has monitored the value of the app by provider usage.

"I was concerned at first that the app might be a short-term use item until the newness wore off," Krenn said. "However, we have seen sustained use over time. I think this validates that these apps are indeed solving a need for our providers that our EHR could not solve alone."

The app helps solve an important need for the health system: It's short on dermatologists, and primary care physicians end up doing a lot of dermatology exams.

"Having this app has helped our providers care for these patients more confidently," Krenn said. "I liken this type of app to smartphone apps. Apple makes great hardware and some good software, but other developers can enhance the experience by adding similar apps or in the case of these apps, extending the use of the core app."

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

While most of the discussion around EHRs and interoperability tends to the negative -- tricky interfaces and misaligned business incentives if not outright information blocking -- heading into HIMSS18 is a good time to also consider some of the progress.  

“There have been great strides made with these companies in terms of improving interoperability, or improving communication between different EHRs,” said Scott Weingarten, MD, senior vice president and chief clinical transformation officer at Cedars-Sinai. 

Virtually all hospitals and providers, or at least the overwhelming majority, have adopted an EHR and that’s a start. Next up: Harnessing EHRs to move to value-based care because of the data they house.

[Also: Purchasing physician time to assist in EHR, workflow decisions improves overall satisfaction]

Specifically, said Weingarten, EHR data can help a provider avoid low-quality care, in which the harms of a test or treatment may outweigh the benefits, or there are no benefits at all. Weingarten sees this a lot with certain drug prescriptions for patients older than 65. Some ill-advised medications can increase the probability of falls resulting in hip fractures, for instance, and there are cost implications there: An otherwise healthy patient having a hip fracture requires additional treatment and is subjected to a potentially avoidable hospital admission.

“There are also tests where there is no value, or limited value,” said Weingarten. “If you take an otherwise perfectly healthy person and do carotid ultrasounds, the data suggests that’s not going to help an asymptomatic, otherwise healthy patient. And it’s going to cost money without providing benefit.

“The EHR can provide benefits in real time in that it can share information with the provider,” he said. “After the fact, data is available to see how many doctors have prescribed low-value tests or treatments in comparison to your peers. When you give providers comparative information … they often respond by reducing their prescribing of low-value care.”

Further elevating EHR’s importance is increased interoperability, which enables different EHR systems to communicate with one another. This allows for a freer flow of information between providers, which is of prime importance when it comes to clinical quality and patient satisfaction.

“EHRs can all talk to each other, similar to ATMs,” said Weingarten. “Anywhere in the world, I can withdraw money from an ATM … because the ATM that I intend to withdraw money from is interoperable with my bank. There was one time I was in a remote area in Argentina, hiking, and I came across a small town and was able to withdraw money from my bank in Los Angeles. So there was that interoperability -- this ATM in Argentina knew I had money to withdraw from my bank. That’s the benefit, when you can communicate patient information between different EHRs.”

This is not just a rosy picture, of course, and there are differing degrees of interoperability, as each EHR system is slightly different. That makes communication between systems difficult at times, but Weingarten said that things have improved in this area in recent years.

”We haven’t achieved an endpoint yet, but my sense is things are going in the right direction.”

That end should encompass quality care, safer and more affordable care, and enabling provider satisfaction -- in other words, selecting a system that facilitates the day-to-day work of the provider rather than slowing them down.

The successful switch to a value-based framework depends on it.

“I think we’ll continue to see a progression of value-based care,” Weingarten said. “Providers who deliver the best care at the lowest cost and provide the best patient experience will grow and thrive, and those provider organizations that do not provide high-value care are going to struggle.”

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

The Government Accountability Office has hit the Coast Guard for failing to implement an electronic health record system and creating havoc by resorting to a paper process.

The House Transportation Committee has scheduled a hearing Jan. 30 to consider the Coast Guard's failure to implement an Epic electronic health record back in 2015.

The Coast Guard canceled the contract two years ago without explanation, according to Epic Systems, the EHR vendor who had won the contract.

[Also: How the Coast Guard’s ugly, Epic EHR break-up played out]

Today, the Coast Guard is tangled in a web of paper processes, which is creating havoc, GAO found.

After canceling the project in October 2015, the Coast Guard could not return to using its electronic legacy system because the technology had been decommissioned in 2015, according to GAO findings.

The agency is recommending the Coast Guard “expeditiously and judiciously” pursue the acquisition of a new EHR, adding that, in doing so, the Coast Guard should ensure key processes are implemented. The government watchdog also called for the establishment of project governance boards to oversee the project.

As for Epic, it posted a project timeline of the abandoned Coast Guard work on its site prior to the GAO report. In the post, Epic noted its work on the project was repeatedly rated “exemplary” by the Coast Guard in formal documented reviews. “Epic was paid in full for the work done,” the EHR vendor writes on its website. “The U.S. Government did not request any refund. The software was ready to go live.”

GAO concluded the Coast Guard could not demonstrate effective management of the project, lacked governance and failed to document lessons learned from the project. Also, relevant documentation was often not available.

“Management told us documentation either did not exist or could not be located because several of the key project management team members were no longer employees of the Coast Guard,” GAO said. 

GAO noted that the Coast Guard also lacked governance mechanisms for its health information system and recommended the Coast Guard develop new performance goals or describe how existing goals are sufficient, publicly report its goals, assess the limitations in performance data are documented, document measurable corrective actions and implementation timeframes, as well as document efforts to monitor implementation of corrective actions. 

The Department of Homeland Security concurred with all five recommendations.

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

To meet all federal, state, CDC and Joint Commission guidelines and mandates, Methodist Hospital of Southern California used its electronic health records system to help build its own in-house antimicrobial stewardship program.

The hospital moved from a time-consuming, paper-based system with incomplete tasks to now completing mandated antibiotic rules on all patients in less than four hours. Hospital staff accomplished this through the in-house creation of custom health issues in its EHR, from vendor Allscripts, to develop advanced patient lists and searches for specific criteria of antibiotic use.

[Also: EHRs in the cloud: Why smaller healthcare providers are making the leap]

Advanced patient lists consist of an antibiotic review of all patients after 48 hours, 7 days and 3 or more antibiotics plus a notification for IV to oral conversion.

“We optimized and automated these functions with a series of custom medical logic modules, informational columns and an easy to read clinical summary view,” said David Ratto, MD, a pulmonary and critical care specialist and a hospitalist at Methodist Hospital. “The end product allowed pharmacists to complete antimicrobial review of all patients, increased pharmacists interventions by 48 percent and decrease our most common antimicrobial usage by 20 percent.”

[Also: Shawnee Mission Medical Center hits Stage 7 in HIMSS Analytics EHR adoption model]

Ratto said the hospital and the staff working on the program learned a variety of lessons coming away from the in-house creation.

“There is an absolute need to have good communication and cooperation between the various departments,” he said. “It was not uncommon that IT did not know the needs of pharmacy and pharmacy did not know the capabilities of what IT could provide. Our project was a cooperative effort between infectious disease physicians, pharmacy, IT and infection control.”

Another lesson learned was the importance of champions representing the project and their departments.

“Unfortunately, during the course of the development of our program, our infectious disease champion died,” he said. “It is extremely difficult to replace a person who acts as a champion for a project. We continue to have issues for the vision aspect. This is even so when a very competent person takes over. They may lack the vision and passion for the project.”

Ratto stresses the importance of an antimicrobial stewardship program in today’s healthcare environment.

“Antimicrobial stewardship is mandated by the Joint Commission, many state agencies and other regulatory agencies,” he said. “This is an extremely important topic because not only did we save our hospital a significant amount of money through our program but we have shown marked quality improvement by decreasing rates of MRSA and C. difficile infections, improved antibiotic sensitivities and decreased readmissions.”

David Ratto will be speaking in the HIMSS18 session, “Creating an EHR-based antimicrobial stewardship program,” at 2:30 p.m. March 8 in the Venetian, Delfino 4004.

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

Patients trust that healthcare organizations will provide safe care. Unfortunately, that trust is often broken, according to the results of a survey of 1,131 patients and family members recently conducted by HIMSS Analytics and sponsored by BD.

More than 96 percent of survey respondents have confidence in their care team to administer medications according to the five rights (right patient, drug, dose, route and time), yet 38 percent know someone who has experienced a medication error. And, one out of five of these patients suffered from “severe repercussions.”

Chris Jerry has firsthand knowledge of the disconnect between expectations and the unfortunate realities of patient care. Jerry’s 2-year-old daughter Emily received extraordinary medical care in 2006 and thus was on her way toward beating cancer.  When his daughter was on her final treatment, a hospital pharmacy technician prepared the wrong intravenous (IV) solution to Emily, however, the consequences proved fatal.

“If the pharmacy just had simple barcode verification in their workflow, and that young pharmacy technician, who didn’t know any better, took that first vial of hypertonic saline and scanned it, alerts would have gone off. And, if that had happened, I am convinced that my beautiful daughter would still be with us today,” said Jerry, who now serves as the founder, president and CEO of the Emily Jerry Foundation.

Putting such safeguards in place, however, is not an easy proposition. “It’s important to understand that the medication process is complex. So, you’ve got a highly complex system with a lot of moving parts, and in complicated systems like that, the likelihood of error can be quite high,” said Tejal K. Gandhi, MD, chief clinical and safety officer for the Institute for Healthcare Improvement. “If you look at the full medication process from the time a physician orders a medication and the order goes to pharmacy and the pharmacist dispenses it, and then it goes to the bedside where the nurse administers it, there is the potential for errors in each of those steps.”

The key to moving toward “zero” errors rests in constructing a system that is purposefully designed to stop the inevitable human errors before they can do any harm. “In the past, when medication error tragedies occurred, everybody would point the finger at the individual healthcare practitioner who is responsible, but instead we need to focus on where did the systems, processes and protocols break down?” Jerry said. “We need to hyper-analyze each event and go back and modify the core systems, processes and protocols so that we can design out that probability of human error from creeping into the equation.”

Gandhi agrees. “The key is to do a really robust cause analysis to understand why the error happened and how to redesign the systems to prevent it,” she said.

The good news is that the healthcare industry has made significant progress in developing and implementing technologies – from computerized physician order entry to automated inventory management systems in pharmacies to dispensing systems that make medications available for patients – that can help eliminate the preventable human errors. As these technologies become more integrated, the information exchange between the solutions becomes more robust, driving healthcare organizations to further protect patients from adverse events.

Comprehensive, integrated IV workflow technology, for example, could help eliminate errors such as the one that led to Emily’s fatality. This integrated system could include IV prep technology, barcode verification and gravimetric technology (which provides independent validation that the IV bag’s final weight is within predefined accuracy limits for the specific compound) that works together to “ensure the proper volume or the right dose of medication goes into the IV bags,” Jerry pointed out.

Certainly, many healthcare organizations have implemented some of these technologies, and increasingly these technologies are integrated together to make a more seamless system. In addition, the industry has made significant strides toward improved patient safety since that day in 2006 when a medication error took Emily’s life. However, healthcare leaders still need to remain dedicated to safety and continue to innovate for the ultimate purpose of improving patient outcomes.

“We're headed in the right direction and are making a lot of progress on medication safety based on those technologies getting implemented. But every new technology can create new problems, so we constantly have to concentrate on what can be done to mitigate those,” Gandhi said. “Healthcare organizations can never feel like they’re ‘done’ because there’s always going to be things that you can do to improve and further prevent medication errors.”

Epic, Optimum Healthcare IT and ECG Management Consultants received Overall Best in KLAS awards in the firm’s new Software & Services report released today.
 
Epic took the top Overall Software Suite category, ranking first for the eighth consecutive year. The EHR giant was also awarded the top overall physician practice vendor. In total, the company received Best in KLAS awards in seven segments and was named category leader in two segments.

[Also: Two Epic shops merge patient portal data]

Cerner, athenahealth and Merge each received two Best in KLAS awards. Cerner won in the Application Hosting and Anatomic Pathology categories, athenahealth received awards for its ambulatory EMR, Practice Management and its Acute Care EMR for community hospitals, while Merge won for cardiology, VNA/image archive and Cardiology Hemodynamics.

The NextGen Healthcare EHR was named the most improved physician practice product for the second year in a row, increasing 10 percentage points over last year.

On the services side, Optimum received the top Overall IT Services Firm for the second year in a row, won two Best in KLAS awards and won one Category Leader award. ECG won Overall Best in KLAS for the Healthcare Management Consulting Firm category.

And for payer-specific technologies, Casenet TruCare won Best in KLAS for care management solutions while Health Solutions Plus MediTrac won Best in KLAS for payer claims and administration platforms. Change Healthcare (Altegra Health) Quality Performance Advisor won Best in KLAS for payer quality analytics.

“Best in KLAS is a recognition of vendors committed to delivering superior solutions,” said Adam Gale, president of KLAS Research. “It gives voice to thousands of providers and payers who are demanding better performance, usability and interoperability in healthcare technology.”

Best in KLAS is based on information obtained from the 2,500 interviews KLAS conducts with providers and payers each month. Annually, these interviews represent the opinions of healthcare professionals and clinicians from more than 4,500 hospitals and 2,500 clinics, and account for 750 products and services from more than 200 vendors.

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

U.S. Representative Duncan Hunter, R-California, told Coast Guard officials at a hearing of the Sub-Committee of House Transportation and Infrastructure Tuesday to consider piggy-backing on the Department of Defense or Veteran Affairs EHRs, rather than shopping for yet another EHR system.

“Why waste money and time to go look for things that exist already, right now?” he asked.

If the Coast Guard were to take Hunter’s recommendation, it could likely mean another new contract for the health IT giant Cerner. Both the DoD and the VA have tapped Cerner for their EHR.

[Also: How the Coast Guard’s ugly, Epic EHR break-up played out]

The Coast Guard remains without an EHR since it abruptly dropped its plans to go live with an Epic EHR more than two years ago. Moreover, it has used a paper-based system since.

A report from the Government Accountability Office paints what some have dubbed a “debacle” as exactly that. According to GAO, the Coast Guard allowed program managers to act without sufficient oversight by acquisition professionals. Even when the Coast Guard established policies to provide oversight for information technology acquisitions – such as the Integrated Health Information System project – they did not implement any oversight, David Powner, director of IT Management for GAO, told the subcommittee.

Powner laid out a number of reasons the project floundered and was eventually abandoned by the Coast Guard when he appeared today before the subcommittee today. He blames the Coast Guard.

Rear Admiral Erica Schwartz, director of health, safety and work-life for the Coast Guard told the subcommittee today the CIO had not been involved in the project, Rear Admiral Michael Haycock, assistant commandant for acquisition and chief acquisition officer for the Coast Guard, added the Coast Guard have since taken steps to improve oversight of projects.

“We understand the Service is following its acquisition policies for the current effort, and has conducted significant research which pointed to a recommended solution of using an existing federal agency system,” Hunter said. “The Coast Guard needs to show what it’s learned and how things have changed, as it works to finally implement an electronic health record system.”

[Also: Shulkin: VA-Cerner EHR deal paused over interoperability concerns]

The cost of the abandoned Epic project was estimated to be $60 million. Epic has noted on its website the government paid in full.

“We need to hear more about the policies and procedures that are now in place to prevent the waste of taxpayer money in the future,” Hunter said.

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

Physicians have a new virtual assistant for their EHR, and her name is Samantha. The technology was launched this past year by Boston-based NoteSwift, and now the AI-powered clinical documentation tool is joining with athenahealth to help docs with their charting.

Samantha is actually a lenthy acronym: Semi-AutonoMous Adaptive Note Transcription Heuristic Algorithm.

That's a lot of words. But the goal is to help athenahealth clients be more efficient with theirs when doing documentation in the athenaClinicals EHR.

Samantha technology can digest the doctor's narrative – whether dictated or typed – and uses AI to parse the information, detect structured data, assign the necessary ICD-10, SNOMED or CPT codes, prepares orders and electronic prescriptions for physician sign-off.

The tool gets that data into the right fields of the EHR, according to NoteSwift, saving the clinician time – as much as eight hours per week – and helping ensure accuracy.

NoteSwift this week announced its partnership with athenahealth's More Disruption Please program and is making Samantha available to the company's 106,000 physicians via the athenahealth marketplace.

Wayne Crandall, president and CEO of NoteSwift, said the tool is a way to help alleviate physician burnout and increase face time with patients.

"Samantha's advanced artificial intelligence creates the entire patient note from a single screen and with just a few clicks," he said in a statement.

NoteSwift bills the Samantha technology as a "real-time scribe, transcriptionist and coder" all in one. The tool comes with its own built-in speech capabilities or works with other products such as Nuance's Dragon Medical, SayIt by nVoq or M*Modal.

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

Cancer is responsible for one in six deaths around the world, and each year there are more than 14 million new cancer cases worldwide, according to the World Health Organization. As healthcare providers seek to enable data-driven, evidence-based cancer care, an explosion of medical information has created both challenges and opportunities to help improve quality of care.

Some 50,000 oncology research papers are published each year, according to PubMed, and by 2020 medical information is projected to double every 73 days – outpacing the ability of human beings to keep up with the proliferation of medical knowledge.

[Also: IBM Watson Health adds international standards for clinical terminology]

In this environment, Swedish oncology IT vendor Elekta is collaborating with artificial intelligence kingpin IBM Watson Health to offer Watson for Oncology as part of Elekta's cancer care systems.

Elekta will market Watson for Oncology as an AI-based clinical decision support system paired within Elekta's digital cancer care systems, including its MOSAIQ Oncology Information System.

Elekta CEO Richard Hausmann said the goal is to apply AI to the cancer care continuum, from treatment planning to evidence-based treatment recommendations.

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

The oncology information systems market is highly specialized and does not feature a lot of players. The dominant companies in the space are Varian and Elekta. Other vendors include Accuray, Epic and RaySearch.

Watson for Oncology was developed by IBM in collaboration with Memorial Sloan Kettering Cancer Center in New York. It can summarize key medical attributes of a patient and provide information to oncologists to help them deliver treatment options based on training from Memorial Sloan Kettering oncologists.

Watson for Oncology ranks the treatment options, linking to peer-reviewed studies that have been curated by Memorial Sloan Kettering. Watson for Oncology also provides a large corpus of medical literature for a physician to consider, drawing on more than 300 medical journals, more than 200 textbooks, and nearly 15 million pages of text to provide insights about different treatment options

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