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    Yale New Haven Hospital, a 1541-bed organization that is part of Yale New Haven Health System, has created a Capacity Command Center to connect real-time data analytics with key services.

    The CCC was developed with the Yale New Haven Health Clinical Redesign initiative, the hospital’s in-house analytics staff and Epic.

    The center emerged from the hospital’s “High-Reliability Initiative,” and also from the leadership and staff commitment to improving all aspects of patient care. The hospital provides care for highest patient volumes in Connecticut.

    “Through the CCC, we’re using the enormous amounts of data available from Epic and other sources to improve care, safety and the patient experience,” Ohm Deshpande, MD, director of Utilization Review and Clinical Redesign at the hospital, said in a statement.

    The center takes the huge amounts of operational data generated by the Epic EHR and generates dashboards to keep nurses, physicians and administrators up to date on changing conditions in real time.

    “Yale New Haven Hospital cares for the most complicated patients in our region,” added Richard D’Aquila, president of Yale New Haven Hospital and Yale New Haven Health. “The Command Center’s people, processes and data infrastructure will allow us to gain real-time insight into our operations, keep the patient at the center of all that we do, and enhance our ability to provide the highest value care.”

    The dashboards show a variety of real-time metrics such as bed capacity, bed cleaning turnaround time, patient transport times, delays for procedures and tests, ambulatory utilization and quality and safety indicators. The stats are visible on the command center screens as well as accessible through Epic by physicians and staff.

    The increased access to data has already driven process changes. For example, the infection prevention staff can identify all patients in the hospital with Foley catheters, review their charts, and consult with nurses and physicians about removing the catheters to avoid catheter-associated urinary tract infections.

    The hospital is five years into a plan aimed at increasing its reliability. YNHH leaders figure a shared set of cultural values will boost safety, quality and patient-centered care.

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

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    Yale New Haven Hospital taps Epic to boost care, patient safety
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    Yale New Haven Hospital taps Epic to boost care, patient safety
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    The hospital worked with Epic to build a Capacity Command Center to synchronize data analytics to specific care services.
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    There is tremendous irony in the fact that so much of the go-live operations management process is often done on paper. One such example of this is how go-live command centers are managed.

    These command centers often are manned by staff who are constantly updating whiteboards, transcribing issues into electronic issue management systems, and manually generating status reports for overall progress. These procedures are cumbersome and add delays into the process of identifying support issues that may be pervasive.

    Leveraging technology to record support issues at the point of incident allows an easier input method and an issue to be triaged more quickly. Simple mobile apps and other technology can be used to record these incidents and electronic dashboards can be used to highlight pervasive issues and generate automated status reports of overall system health.

    A digital command center is hugely successful for an electronic health records implementation when all parties are committed to its success, said Matthew Ernst, director of training, documentation and support for digital innovation and consumer experience at Thomas Jefferson University.

    “Our EHR implementation occurred in two phases,” Ernst explained. “During the buildup to phase 1, my team met a lot of resistance from all the EHR teams and consultants on the use of tablets, on the use of an online portal to submit issues to an IT service management system, and on the use of performance analytics instead of spreadsheets. Comments varied from we have always done it this way to this is going to fail as staff will not be able to use the technology to keep up with the demand.”

    During the first phase of the go-live, the attitudes and perceptions changed as the teams saw the technology working, and realized how much easier and more efficient it was for their work and saw the improvements in the consumer experience, Ernst said.

    “As soon as the phase 1 go-live ended, the EHR teams were knocking down our doors to expand the use of technology with more tablets on the floor, enhanced workflows within the ITSM and expanded performance analytics dashboards,” Ernst said. “The use of technology-enabled a faster, more efficient implementation and saved us more than $100,000 just in the elimination of the paper conversion.”

    There is always resistance to change, though. During discussions with the EHR implementation team and their consultants, the concept of a digital command center was met with great resistance. Their approach was to use the same methods always used for an EHR go-live – use of paper forms for issues that are faxed to the command center and manually converted to an ITSM, and issue tracking and trending via excel spreadsheets.

    “The consensus was that any changes in these processes would cause mass confusion and a failure at go-live,” Ernst said. “It was interesting as these are the same people who have the latest smartphone and would never think of using a flip-phone.”

    Ernst will speak on the subject at the HIMSS18 Conference & Exhibition during an educational session on March 7 entitled “Digital command center for EHR implementation.”

    Ernst said session attendees will learn many things about digital command centers, including that the obstacle is the way and innovation and change require perseverance and commitment.

    “The obstacle is the way – be one with the problem and you will own the solution – many times in health IT, a solution is provided for a problem without truly understanding what it is and has it been addressed,” Ernst said. “This is one of the reasons why solutions fail or underperform due to a low adoption rate. IT has to be a partner with the client to truly understand the problem and have them be part of the ownership of the solution.”

    And innovation and change require perseverance and commitment, he said. Many times changes and innovation are tied to the initial costs and/or efforts with little credence given to long-term savings and/or efficiency gains.

    “In our example, the initial consensus was to use a paper form and fax it into the command center instead of spending $30,000 for the tablets,” he explained. “Our argument that there are issues with faxing, that forms are illegible for the analysts, and there is a cost to convert these into our ITSM system, started to gain traction, but in itself didn’t solidify the decision.”

    The decision to move ahead was made when it was discovered that another parallel project going live after the EHR implementation required the use of tablets. The tablets were able to be used for both projects, thereby eliminating the extra costs.

    “The end results are that the digital process was more efficient and consumer-friendly and provided more than $100,000 savings in staff time through the elimination of the paper conversion,” he added.

    Health IT is under tremendous pressure to do more with less as demand continues to grow and it becomes no longer practicable to throw additional resources at a project.

    “There needs to be creative and innovative approaches to problems where the client is a partner and has ownership in the solution,” Ernst said. “Otherwise, health IT will be seen as a cost center and not as an integral part of the health system. In our case, the real accomplishment was the partnership and ownership built across teams to develop a solution that delivered short-term and continuous long-term benefits. Digital was just the method of delivery.”

    Matthew Ernst will be speaking in the session, “Digital command center for EHR implementation,” at 4 p.m. March 7 in the Venetian, Palazzo G.

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

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    Digital command center for EHR implementation gains efficiencies and saves $100,000
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    Digital command center for EHR implementation gains efficiencies and saves $100,000
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    A digital command center can add value and efficiency to an organization’s go-live operations, says a Thomas Jefferson University executive.
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    Obtaining HIMSS Stage 7 recognition is a definite milestone for any organization, yet many hospitals perceive the process of obtaining HIMSS Stage 7 as overwhelming.

    But hospitals should understand how the HIMSS Stage 7 process can help a healthcare organization realize the importance of using an electronic health record system to reach its full potential through HIMSS application and recertification. Hospitals should understand how HIMSS Stage 7 can help an organization realize the importance of using an EHR to reach its full potential.

    Hilo Medical Center has achieved HIMSS Stage 7 recognition and has learned some important lessons along the way that reinforce these points.

    One such lesson learned is that achieving HIMSS Stage 7 is a hospital-wide effort, said Kris Wilson, CIO at Hilo Medical Center.

    “Often we refer to EHRs as an IT-based project or initiative,” Wilson said. “In reality, IT provides the means to implement the technology, but the use of the EHR and achieving a paperless environment requires all disciplines to use and adopt an electronic workflow. It is imperative to your success to engage as many people as possible within your organization when reviewing what Stage 7 means to your hospital.”

    Another lesson learned along the road to Stage 7 is that ultimately achieving HIMSS Stage 7 keeps the whole organization current, Wilson explained.

    “Adopting the guidelines of the HIMSS Stage 7 measures and infusing these measures into our culture, we found as an organization that we were better prepared to address Meaningful Use standards and federal mandates,” she said.

    “Having a basic project plan on how to reach each measure will keep your team on track,” she advised. “Taking each measure and breaking it down into functional parts will make the process achievable.”

    She also hopes to convey how to select a good case study on which a healthcare organization can focus.

    “This is one of the more daunting tasks of the HIMSS Stage 7 process, but if you take a step back and look at how much you are already doing, you will be surprised on the many topics you can report upon,” she explained.

    At a macro level, it is important for hospitals to maintain similar functionalities and workflows. Adopting comparable health information practices facilitates the flow of information between healthcare entities and helps care coordination.

    “The future of healthcare is driving all organizations to decrease redundancies and increase efficiencies,” Wilson said. “One way to do this is to strive for a paperless environment. Reaching HIMSS Stage 7 provides a good guideline on how to achieve this.”

    Kris Wilson will be speaking in the session, “Achieving HIMSS Stage 7: Realizing the benefits of your EHR,” at 4 p.m. March 8 at the Wynn Hotel, Alsace.

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

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    HIMSS Stage 7 hospital offers lessons to help others striving for the top goal
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    HIMSS Stage 7 hospital offers lessons to help others striving for the top goal
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    Hilo Medical Center has achieved HIMSS Stage 7 recognition and discusses, among other things, how help from everyone within an organization is needed.
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    Johns Hopkins Aramco Healthcare in Saudi Arabia is live on its Epic System EHR, executives announced today. It is Epic’s first implementation in the Kingdom.

    JHAH CEO Daniele Rigamonti, MD, said the system is the first Epic shop in Saudi Arabia. 

    “This is a landmark step toward achieving our vision, which is to be a regional leader in clinical outcomes and the advancement of health professions and marks a new era in healthcare at JHAH.”

    Johns Hopkins Aramco Healthcare Company– JHAH – is the result of a joint venture between Saudi Aramco, a world leader in energy, and Johns Hopkins Medicine, a leading academic health system. The organization is designed to drive and boost community wellbeing by providing innovative, integrated and patient-centered care to Saudi Aramco’s employees and healthcare beneficiaries.

    [Also: Epic introduces new One Virtual System Worldwide interoperability initiative]

    The new HR also provides data and utilization analytics to help leadership and staff make real-time adjustments to best serve patients, Epic executives noted.

    “It’s our first project in the Kingdom, and our teams were both very excited to go live,” Epic President Carl Dvorak added. “The JHAH team has been very focused on making technology work for both the provider and the patient.”

    About 1,000 trained staff members were on site to provide technical support for the go live. Epic executives say they provided 50,000 hours of training to the JHAH staff. Fourteen percent of eligible patients pre-registered for My Chart, Epic’s online patient portal. 

    Fifteen thousand patients had pre-registered for MyChart, and an additional 11,000 registered in the days following, according to Epic.

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

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    Epic EHR now live in Saudi Arabia
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    Epic EHR now live at Johns Hopkins Aramco Healthcare in Saudi Arabia
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    Hospital CEO said it is the first in Saudi Arabia to go-live on Epic.
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    In December 2017, Chicago's Advocate Health Care announced that it would merge with Aurora Health Care of Milwaukee, Wisconsin – an $11 billion meeting of giants that would create the 10th-biggest not-for-profit health system in the U.S.

    Aurora runs on an electronic health record platform developed by its home state's own Epic Systems. It was announced Feb. 1 that now Advocate will too.

    The health system didn't put a price tag on the rollout, but Advocate officials said they expect the project to take about three years. The new EHR and revenue cycle management system will require training for more than 17,000 physicians, nurses and associates.

    [Also: Advocate applies predictive analytics to patient-centered care for reducing readmissions]

    Advocate is a longtime health IT leader, with deep experience in complex clinical integration and population health management.

    In 2014, it had announced plans to merge with NorthShore University, another Epic client. The deal was dropped in 2017 amid antitrust concerns, but it could have required a decision on how to integrate its own disparate systems – Cerner for hospitals, eClinicalWorks for the patient portal, and Allscripts for its Advocate Medical Group.

    Now, with the planned Aurora merger, officials say the new single-platform Epic system will allow it to continue to hone its care coordination activities and focus on improved patient outcomes.

    [Also: Advocate and NorthShore mega-merger an interoperability case study]

    Specifically, execs also pointed to Epic's consumer capabilities and ease-of-use for clinicians as big reasons for the switch.

    The health system has been pursuing an array of consumer-facing innovations recently, such as expanded online scheduling, digital check-ins, chatbots, mobile patient portal access, online health risk assessments and more.

    “Advocate has been laser-focused on our transformational efforts around safety, outcomes and consumer experience, and our decision to move to a single platform is yet another demonstration of our commitment to accelerate results and reimagine health care delivery for those we serve,” said Advocate CEO Jim Skogsbergh in a statement.

    Advocate's Chief Information Officer Bobbie Byrne, meanwhile, said the switch to Epic will enable better care coordination across the health system and beyond, allowing for "better interoperability throughout our entire geographic region, benefiting patients through a seamless, integrated approach.

    "We are confident this single-platform EHR will be a nimble, long-term solution that can be continually adapted and developed as technology advances to keep us on the leading edge," she said.

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

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    Advocate Health Care switches to Epic EHR
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    Advocate Health Care switches to Epic EHR
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    Following its announced merger with Epic client Aurora, the health system says the single-platform will replace its mix of Cerner, eClinicalWorks and Allscripts.
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    In its fourth quarter and 2017 earnings report, athenahealth beat Wall Street predictions yesterday with strong revenue growth for both Q4 and the calendar year.

    Athenahealth stock jumped more than 17 percent with the news.

    In 2017, the cloud health technology vendor posted 14 percent revenue growth over Q4 2016, and 13 percent growth over the full year.

    [Also: 7 quotes from Jonathan Bush on athenahealth's 'painful' quarter]

    For the three months ending December 31, 2017, athenahealth's total revenue was $329.2 million, compared to $288.2 million for the same period in 2016. Wall Street analysts had expected revenue around $320 million.

    Net income for the quarter was $31.6 million, compared to $9.8 million for the same period in 2016 – a year-over-year change of more than 222 percent.

    Total revenue for 2017 was $1.22 billion, compared to $1.08 billion in 2016. Net income for the calendar year was $101. million, compared to $76 million the year before.

    [Also: Athenahealth partners with NoteSwift on AI-powered EHR documentation]

    It's all welcome news for athenahealth, which has had a challenging go of it recently – responding to the pressures of an activist investor, replacing its chief financial officer, laying off 9 percent of its workforce and reducing spending by $115 million.

    Athenahealth CEO Jonathan Bush said in a statement he was "proud of all that we accomplished" in 2017.

    "It was an extraordinary year of network growth. We surpassed the 100 million patient threshold and now serve more than 100,000 healthcare providers," said Bush. "We also took action to create a more focused and efficient company and enhance the depth of talent on our board and management team."

    "As a result, athenahealth is better positioned to drive increased levels of profitable growth and enhance shareholder value,” he added. In 2018, I look forward to continued progress on our journey to transform the healthcare industry."

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

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    Athenahealth revenue jumps 13%, beats expectations
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    Athenahealth revenue jumps 13%, beats expectations
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    Just three months after it revised its expectations for 2017 earnings and announced big layoffs,  the company signed new clients in Q4 and kept a lid on expenses.
    HOT @HIMSS: 

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    The increase in patient engagement efforts in recent years has caused some basic rethinking of long-held assumptions about how to foster wellness. Technology is a big must-have, of course. But what about the ownership of data?

    Hugo Campos never thought too much about that issue until about 10 years ago, when he was equipped with an implantable cardioverter defibrillator.

    "Receiving that in 2007 was the beginning of my patient advocacy," said Campos, an emeritus member of the Stanford Medicine X executive board and a self-proclaimed data liberation advocate. "My background is not in health or health IT," he said. "I worked in advertising."

    But Campos' frustrations with his ICD data caused him to change his career trajectory.

    "The standard of care these days is to monitor these devices remotely," he explained. "The manufacturer is usually tasked with the data collection by the hospital or the clinic."

    "Patients have no access to that stream of data, that stream of information that is constantly flowing to the manufacturer and to the clinic," he said. "I find that to be an absurd obstacle to engagement."

    At the HIMSS18 Patient Engagement & Experience Summit, Campos, alongside his Stanford Medicine X colleague Larry Chu, MD,  professor of anesthesiology, perioperative and pain medicine, who runs the program, will explore the value of data liberation, and how a push toward more participatory medicine could lead to patients moving past mere engagement and toward more "autonomy" and better partnerships with their care teams.

    More and more patients are finding themselves part of movements that they might otherwise have never considered, said Campos. "The quantified-self movement, the e-patient movement, participatory medicine, they've all started to converge, creating these really engaged people."

    But for many patients, especially those with implantable devices like him, "remote monitoring is an obstacle," he said. Millions of people live with those implanted devices, but are limited in their ability to engage with their own health because "they have no access to the data."

    As patients are entrusted with more responsibility for their own care, limited access to their own data is "the most obvious obstacle to engagement in my view," said Campos.

    "If you want engagement, you have to design for autonomy," he said. "For me, autonomy is sort of the elephant in the room. Nobody wants to acknowledge that what people want isn't engagement with healthcare – it's engagement with life. That's what people want."

    In other words: A person living with a chronic condition "doesn't want to engage with portals, with doctors, with the healthcare system," he said. "People have different needs and different desires and different goals. It should be about allowing people to use the system in the way that works for them."

    That sort of autonomy and agency comes with responsibility, of course.

    "You have to imbue in people the sense of responsibility and the notion that they really should be driving their healthcare as much as they drive their lives," said Campos. "It's important to make people realize that the doctor can't solve all their problems, that they really need to step up. They really need to do what they think matters to them. Help themselves, educated themselves.”

    The HIMSS and Healthcare IT News Patient Engagement & Experience Summit will be on March 5 at the Wynn Hotel in Las Vegas. Register here.

    HIMSS18 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.

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

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    Reshaping access to data is required for patients to be truly engaged
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    Reshaping access to data is required for patients to be truly engaged
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    Stanford Medicine X advocate says the success of value-based care, precision medicine depends on barriers being removed to patients' own health information.
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    Charlie Hart, a pharmacy informaticist at Mercy Health, a four-hospital health system in northern Illinois and southern Wisconsin, is advocating for a rethink of medical alerts. He envisions alerts that are so relevant they would no longer be ignored.

    Hart advocates alerts at the most effective point in the workflow and for integrating information from the electronic health record, with a drug knowledge database. As he sees it, this makeover would reduce nuisance alerts. Instead, warnings would provide guidance to boost clinical care.

    "The EHR contains a wealth of information about the patient," he said.

    [Also: Innovaccer's new alert system integrates with EHRs without adding to clinical workflow]

    But the problem is that traditional medication alerts do not leverage most of this EHR information. Vendors can be slow to program new functionality, he said, because they have a 12-to-18-month release cycle and they need to support multiple drug database products.

    In turn, this makes it hard for the EHR vendor to develop and support additional advanced medication alerts features that are not supported by all drug database vendors.

    Hart suggested employing a consolidated clinical document architecture to combine the patient information from the EHR and the critical medication information from the drug vendor database vendor. Those steps would allow for the integration of patient-specific information into medication alert systems.

    [Also: EHR fatigue has frustrated doctors looking to cut clinical hours]

    What information is often lacking for caretakers? Traditional medication alerts are triggered by the medication, Hart pointed out.

    "Basic patient information like age, sex, comorbidities and key labs are not evaluated when deciding if a medication alert is applicable to the patient and should be displayed to the clinician," he explained.

    So hart champions more specific medical alerts.

    Traditional drug-to-drug interactions evaluate drug pairs, and if two drugs are known to interact with a high enough severity, an interruptive alert will be displayed to the clinician, he said.

    When assessing the drug-to-drug pair, key patient information is not evaluated, Hart added. However, by incorporating these additional patient-specific factors, the decision to display an interruptive alert to a clinician can be more precise and more specific to the patient.

    Hart is scheduled to present at the HIMSS18 session, “Zeroing in on the patient to reduce alert fatigue,” at noon March 9 in the Venetian, Murano 3304. 

    HIMSS18 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.

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

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    Why integrating EHR data into alerting system can reduce fatigue
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    Mercy Health pharmacist: Integrate EHR data into alerting system to reduce fatigue
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    A consolidated architecture that combines patient data EHR with medication information could enable more informative and actionable medication alert systems, Charlie Hart says.
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    Artificial intelligence start-up Medial EarlySign in a new study has shown how the combination of AI and EHR data can facilitate early detection and treatment of kidney problems and can help slow down – or even prevent – progression to end-stage renal disease.

    Medial EarlySign's machine learning-based model analyzed dozens of factors residing in electronic health records, including laboratory test results, demographics, medications, diagnostic codes and others, to predict who might be at high risk for having renal dysfunction within one year.

    By isolating less than 5 percent of the 400,000 diabetic population selected among the company's database of 15 million patients, the algorithm was able to identify 45 percent of patients who would progress to significant kidney damage within a year, prior to becoming symptomatic, the start-up reported. This represents 25 percent more patients than would have been identified by commonly used clinical tools and judgment, the company contended.

    [Also: Special Report: AI voice assistants have officially arrived in healthcare]

    "Immense efforts are invested in developing treatment protocols to reduce the number of patients who will develop renal dysfunction due to diabetes," said Ran Goshen, MD, Medial EarlySign’s chief medical officer. 

    Goshen added that the startup’s algorithm can be used by hospitals, insurers and pharmaceutical companies to manage resources to reduce the likelihood for end-stage renal diabetes.

    AI in healthcare is beginning to emerge out of its infancy, said Ted Willke, a senior principal engineer at Intel Labs.

    "We're seeing healthcare organizations and hospitals move beyond AI-based proof-of-concepts and program pilots into developing and adopting systems that work the best for their needs," Willke said. "AI in healthcare, like in other industries, began as a way to help these organizations manage their vast amounts of data and simplify daily tasks, but we're starting to see the emergence of truly innovative uses of AI in healthcare – from finding complex patterns in medical imaging to genomic sequencing to designing patient treatment plans."

    Additionally, right now, there's a huge interest in predictive clinical analytics or the process of inputting historical patient data into models to identify and forecast future events, he added.

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

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    AI mines EHR data to predict diabetic patients at risk for kidney damage, study finds
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    AI mines EHR data to predict diabetic patients at risk for kidney damage, study finds
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    Researchers found that using machine learning algorithms pinpointed 25 percent more people at risk of diabetes than clinical tools and human judgment.
    HOT @HIMSS: 

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    Reporting electronic clinical quality measures is difficult, and even more for the many hospitals running multiple EHRs, but there are steps hospitals can take to ease the burden. 

    Among the hardest parts is continuing to report eCQMs once a new, single EHR is selected and a rolling 12-month implementation plan is in place, according to Mary Burton, group manager of clinical quality reporting at BJC Healthcare in St. Louis, Missouri. 

    Burton said that aligning Joint Commission and CMS reporting into one comprehensive, cohesive system would alleviate some of the pain. When national regulatory bodies are not aligned or standardized, she noted, any efficiencies gain with automation are weaker because of the need to develop, test, and validate two distinct work products.

    “We have learned from chart-abstracted core measures that when national regulatory bodies are not aligned or standardized, any efficiencies gained with automation are diminished by the need to develop, test, and validate two distinct work products,” Burton noted.

    But the best approach to eCQM reporting is getting the right people to lead the effort. Also, she sees a need for flexibility when it comes to data capture, in a way that is well aligned with the nurses’ and doctors’ day-to-day work. 

    “The ability to expand beyond the vendor’s configuration of EHR as the single source of data capture is essential,” she added. 

    As hospitals become proficient in reporting, the challenges are beginning to ease.

    “Development of measures with hospitals doing some testing in a live setting is very helpful. If at all possible, avoid a rush to production,” she cautioned. “Make sure the measures really work before making them mandatory. Propose measures and allow for feedback.”

    Burton and Liz Richard, managing director at Encore, A Quintiles Company, are scheduled to speak during the HIMSS18 session, “Managing eCQM Reporting Through a System EHR Transition,” at 10 a.m. March 8 in the Venetian Palazzo G.

    HIMSS18 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.

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    Email the writer: bernie.monegain@himssmedia.com

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    Tips to make eCQM reporting smoother when managing multiple EHRs
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    Tips to make eCQM reporting smoother when managing multiple EHRs
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    Hospitals can improve the overall process by getting the right people involved, institutions flexibility of data capture, and create a feedback loop.
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    Pickens County Medical Center, a 56-bed community hospital in Carrollton, Alabama, will roll out an integrated electronic health record across its acute and ambulatory facilities.

    PCMC selected Cerner CommunityWorks, a cloud-based model of Cerner Millennium. It is designed to support the unique needs of community healthcare organizations.

    More and more smaller providers are opting for cloud-based electronic health records and the vendors are bringing offerings to market to meet that demand. 

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

    eClinicalWorks last fall announced the new version of its cloud-based EHR, eClinicalWorks 11, while Meditech revealed Meditech-as-a-service, a hosted edition of its EHR designed specifically for critical access hospitals, and athenahealth of course plays in the same space. 

    Epic CEO Judy Faulkner has said that two new versions of its EHR targeted at smaller providers will become available in March 2018. 

    PCMC CEO Richard McBryde said in a statement that after a six-month review of five companies it based the decision on four key points: ease of use, regulatory support, and training before and after go-live.

    The hospital operates a primary care clinic and an emergency department with six exam rooms and two trauma suites staffed 24/7.

    Cerner’s CommunityWorks platform provides physicians with a digital record of a patient’s health history, including clinical and financial data. Through the new online patient portal, consumers will be able to securely message physicians, schedule appointments, view and settle balances and access their health history.

    Four other hospitals selected Cerner CommunityWorks in the past month: Martin County Hospital District, in Stanton, Texas; Crawford Memorial Hospital in Robinson, Illinois; Perry County Memorial Hospital in Perryville, Missouri; and Astria Health in Yakima Valley, Washington.

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    Pickens County Medical Center chooses Cerner for cloud-based EHR
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    Pickens County Medical Center chooses Cerner for cloud-based EHR
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    PCMC becomes the latest hospital to turn to a hosted electronic health record.
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    EHR giant Cerner reported its latest quarterly earnings on Tuesday, describing the fourth quarter as a “solid finish” with bookings up and earnings lower than expected. 

    “We finished the year on a mostly positive note, with record bookings and all other key metrics except for earnings in line with our expectations,” Cerner President Zane Burke said. 

    Bookings in the fourth quarter were $2.3 billion, the highest ever and an increase of 62 percent compared to $1.4 billion in the fourth quarter of 2016. Also, 2017 bookings for the full year came in at a record $6.3 billion, up 16 percent compared to 2016 bookings of $5.4 billion.

    On a U.S. Generally Accepted Accounting Principles (GAAP) basis, fourth quarter 2017 net earnings were $336.7 million while fourth quarter 2016 GAAP net earnings were $149.7 million. For the full 2017 year GAAP net earnings were $867.0 million against 2016 $636.5 million in 2016.

    As for the fourth quarter, revenue was $1.3 billion, an increase of 4 percent compared to $1.2 billion in the fourth quarter of 2016. Full-year 2017 revenue was $5.1 billion, up 7 percent compared to 2016 revenue of $4.8 billion.

    Cerner signed six contracts greater than $75 million in the quarter, Burke said, including an expanded relationship with Adventist Health.

    It was a good year for Cerner’s revenue cycle business, with 15 percent revenue growth and more than 50 percent bookings growth. “This was driven by the inclusion of revenue cycle in almost all new EHR deals as well as increasing penetration of revenue cycle in our base,” Burke said.

    After stumbling three months ago, Cerner reported record new business bookings in the final three months of 2017 that were 62 percent higher than a year earlier.

    The $2.3 billion bookings of new business in October, November and December followed a disappointing bookings number in the previous quarter that contributed to a sharp drop in Cerner’s share price.

    Bookings also reached a record $6.3 billion for the entirety of 2017. 

    “Our bookings were at record levels across several key areas, including population health, Cerner ITWorks, and revenue cycle,” he said, adding that business outside the United States was strong and bookings of new business and potential new business still in the pipeline signal growth in 2018 and beyond.

    One major contract, however, remains open: the U.S. Department of Veterans Affairs massive project to modernize its proprietary VistA EHR. The VA has yet to sign a contract as expected in the quarter, Burke said. The delay was primarily related to the VA’s decision to conduct an external validation process to ensure their interoperability requirements can be met.

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

    “We welcomed this review as we are confident in our interoperability capabilities and believe it’s good to have the requirements clearly defined,” Burke added. “We also like that the VA is focused on pushing for interoperability across the industry, something we have long supported,” Burke said. He expects the VA will sign the contract soon, he added.

    Piper Jaffrey analysts Sean Wieland and Nina Deka weighed in, asserting that the delay of the VA decision has caused Cerner to “eat upfront readiness costs on the contract.” Further delays could cause future misses, they write, while expansions could cause upside to guidance. 

    “The VA is pushing for interoperability across the industry and platforms, which we believe Cerner excels at, so we don't believe there is a risk of the VA changing course,” the analysts conclude.

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    Artesia General Hospital is in the validation process for Stage 6 of the seven-stage HIMSS Analytics Electronic Medical Record Adoption Model, or EMRAM. Director of IT Eric Jimenez and his team faced and overcame various challenges along the way and have lessons to share.

    "The journey this hospital and department has been on for the past four years has been amazing," said Jimenez. "The department started with three people and now has 17. In 2015, we implemented an EHR in 90 days, replaced our PACS system, and installed a new medication system at the same time. As the environment was changing around us, the hospital grew from 250 to 420 employees."

    [Also: Artesia General Hospital's small IT team goes big on 'cool tech' investments]

    There was a turning point to this story: Jimenez almost was let go 18 months ago. Team morale was low, the physicians weren't happy with the EHR, the list goes on. Luckily for Jimenez, and ultimately the hospital, he got a new boss.

    "This was the catalyst that helped me," he said. "We started changing the mindset around the hospital, and now we are making great things happen, like EMRAM Stage 6. I am truly excited about the future at the hospital."

    Challenges to getting to EMRAM Stage 6 included: difficulty reaching an agreement with physicians on what constitutes complete clinical documentation; physicians not seeing the value of EHR templates; and implementing clinical protocols.

    [Also: 9 executives share what their dream hospital IT employees have in common]

    "That is a difficult procedural and political issue for a small hospital," he said. "At the end of the day, all of these challenges affect physician workflow, and that is the biggest issue."

    To overcome these challenges, Jimenez and his team developed a clear IT strategy for the hospital that helped with communicating priorities. That strategy contained EMRAM elements. The IT team presented its plan to senior management and the board, and they agreed to the strategic direction.

    "We built a partnership with our EHR vendor, Evident," he explained. "In order to get the most function out of the system, our clinical analyst would spend hours working with Evident to gain full understanding of the system."

    The next step was to create an education program to train end users. When new providers would onboard, the analyst would focus on how to use the system, often tailoring education to a  provider's skill set; sometimes training would take weeks or even months. The major topic was CPOE.

    And the IT team continued work on building and refining templates to ensure best practices.

    "In order to help the providers change their minds about templates, we needed new technologies," he explained. "We implemented Dragon Medical One to help them use the templates. In addition, we worked with our EHR vendor to use built-in micros so they could easily type or say phrases that would fill in templates with ease. We created a monthly meeting to keep providers informed about changes."

    Jimenez said the process of getting to EMRAM Stage 6 was difficult.

    "At Artesia, we attempted to reach Stage 6 two years ago, but failed to meet the measure due to the then-newly completed implementation of an EHR, the brand new PACS system, and the brand new medication system," he said. "As we worked toward Stage 6 this year, the full support and backing of our administration, the partnerships built between departments, the solid IT plan, and making the project organization-wide helped us achieve the stage."

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    HIMSS announced on Wednesday that its Health 2.0 unit will now be hosting MarketConnect Live at HIMSS18 to connect technology companies with prospective healthcare customers. 

    MarketConnect Live is designed to accelerate healthcare technology buying and selling by giving hospitals, payers and pharmaceutical companies a digital platform for evaluating vetted technologies. 

    The invitation-only MarketConnect Live will be from 3 to 6 p.m. March 7 for in-person 25-minute meetings. 

    Market Connect Live heads to HIMSS18 after a recent successful event at Health 2.0's 11th Annual Conference. The 2017 program matched 25 top healthcare organizations with 18 tech companies through more than 70 curated sales meetings.

    "There are thousands of digital health startups out there and we all know how challenging it is to sift through the noise,” Health 2.0 Executive Vice President Indu Subaiya said. “MarketConnect Live is designed to expedite the procurement process by strategically connecting relevant buyers and sellers who are positioned to engage in commercial discussions."

    EHR vendor Allscripts is the exclusive event partner.

    HIMSS18 runs from March 5-9 in Las Vegas. 

    HIMSS18 Preview

    An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.

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    A U.S. District Court judge in Florida has rejected allegations that EHR giant Epic Systems broke the law by overbilling for anesthesia procedures.

    The ruling comes as other EHR vendors, notably eClinicalWorks and Allscripts, have lawsuits filed against them.  

    The plaintiff in Epic’s case, Geraldine Petrowski, failed to meet the heightened pleading requirement for claims alleging fraud and was lacking facts, concluded Florida U.S. District Judge James S. Moody Jr.

    “Petrowski does not allege any facts about the alleged misrepresentation, like whether it was oral or written, what it consisted of, who made it and to whom, when it was made, where it was made, what claim was actually submitted to Medicare, by whom it was submitted, or when it was submitted,” he wrote in his conclusion.

    Epic spokeswoman Meghan Roh issued this statement: “As we previously stated, the plaintiff’s assertions represented a fundamental misunderstanding of how claims software works. We are pleased the court dismissed this case.”

    In her suit, filed in 2015, Petrowski alleged that a glitch in the Epic billing system had resulted in hundreds of millions of dollars of overbilling.

    [Also: Epic sued over millions in alleged anesthesia over-billing; Company stands by system]

    Petrowski, who worked at WakeMed Health in Raleigh, N.C. between 2008 and 2014, filed the complaint, charging that Epic’s billing software defaults to charging for both the applicable “base units” for anesthesia provided on a procedure as well as the actual time taken for the procedure, resulting in payers being overcharged for anesthesia.

    “This unlawful billing protocol has resulted in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims,” Petrowski wrote in her complaint.

    Had Petrowski prevailed, she might have been up for a whistleblower award from the government.

    If the Justice Department enters a case begun by a whistleblower, prosecutes the case and wins, the whistleblower is entitled to a maximum of 25 percent and a minimum of 15 percent of any funds recovered by the government as a result of the verdict or settlement.

    Petrowski served as hospital liaison for WakeMed’s rollout of Epic’s software, when she came across the anesthesia billing issues, developing “major concerns” about incorrect billing, she said in the complaint.

    She worked as a compliance review specialist from September 2008 to September 2012 and then as the supervisor of physicians’ coding through May 2014. In 2015, she was the liaison for the hospital’s Epic go-live.

     

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    Columbia University College of Dental Medicine this week announced that it will establish a new Center for Precision Dental Medicine, which will make heavy use of technology to enable data-driven research, advancing understandings about the link between dental and overall health.

    By applying analytics to multiple data streams, including both medical and dental electronic health records, the center aims to advance education and bring oral health care into the age of precision medicine, officials say.

    Christian Stohler, Dean of the Columbia University College of Dental Medicine, said the new center will deploy "digital technology and information science to stretch the boundaries of dental research, relating oral care to overall health care, and putting the 'mouth back into the body.'"

    [Also: Call for speaking proposals: HIMSS Precision Medicine Summit]

    The school is planning several initiatives over the next two years to help break down some of the longstanding silos between medicine and dentistry –boosting the use of predictive analytics for better disease prevention and helping improve dentistry's standing for the transition to value-based care.

    "Deep data mining could pave the way for systems of care that continually assimilate new evidence showing which treatments are most effective, offering personalized diagnoses and treatment plans based on thousands of parameters," said Stohler.

    The College of Dental Medicine will be among the first academic dental institutions to unify dental and medical patient records in Epic electronic health records, officials say – enabling them to be shared among clinicians at Columbia, NewYork-Presbyterian, Weill Cornell Medicine and Harlem Hospital.

    Physicians and dentists usually work independently of each other, but this integration will offer a two-way flow of information to help caregivers detect and manage interrelated chronic conditions. Dentists are often the first to notice oral conditions that can be related to chronic diseases, such as diabetes and certain cancers.

    Clinicians will also be able to access some patients’ genomic information – when it's voluntarily shared with the school – to help tailor personalized treatments.

    Columbia is also aggregating anonymized data from patient visits to help researchers study evidence-based connections between oral and overall health, procedures and outcomes, stress levels and health, among the range of topics, officials say, with the aim of fostering more real-time provider feedback and predictive analytics for precision care.

    The Center for Precision Dental Medicine also aims to drive improvements in education, through tools such as video cameras, mobile devices and live-streamed real-time procedure data. It will also deploy new dental tools that come equipped with RFID technology to show how procedures are performed for better assessment and faculty feedback.

    With an eye toward financial and operational efficiencies, it also plans to roll out several new technologies to track instrument and supply use, ensure safety precautions, address patient wait times to helping future dentists better manage costs and improve patient satisfaction. Dentistry is also moving toward value-based reimbursement, officials point out, and predictive analytics and precision-based care will toward those goals.

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    Parsons, Tennessee-based Decatur County General Hospital is notifying 24,000 patients of a breach, stemming from a hacker remotely installing software onto its electronic health record software to generate digital currency.

    DCGH’s EHR vendor notified officials on Nov. 27 that a hacker installed software to generate cryptocurrency onto the server managed by the vendor. Officials said the investigation is ongoing, but it looks like the cybercriminal accessed the EHR’s server to install the malicious software.

    Hackers have continued to target the healthcare sector this year. However, this is one of the first reports of a hospital’s EHR being hit with cryptocurrency mining software.

    What’s interesting is that the vendor discovered the unauthorized installation on Sept. 27 and replaced the server about four days later. The notification did not mention why the vendor waited two months to notify the hospital of the breach.

    The infected server contained patient names, Social Security numbers, addresses, dates of birth, clinical data and insurance information.

    While it appears the hackers’ intent was to leverage the cryptocurrency software, the investigation was unable to definitively prove hackers didn’t view or access patient data. All impacted patients are being offered one year of free credit monitoring.

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    Ensuring that EHRs are affordable, accessible and well-operated is unachievable for many small healthcare sites, which can foil digitally well-appointed health systems that need them as care partners. This whitepaper shows how those gaps are closing.

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    Children’s Mercy Kansas City, a pediatric medical center, announced that it will deploy Cerner’s Millennium EHR. 

    Children’s Mercy will implement Cerner’s full suite of solutions, based on Cerner Millennium EHR architecture.

    Mercy will be replacing multiple disparate platforms with a single integrated system to streamline operations and to help caregivers make data-driven decisions at critical points during a patient’s care.

    [Also: Digital transformation recipe for hospitals: consumerism, IoT and personalized medicine]

    Medical devices will be integrated to securely transfer data from bedside devices to the EHR in near real time. Mercy will also roll out efficient scheduling and billing platforms and population health management technology to help identify gaps in care. 

    “The electronic flow of clinically relevant information will help improve our physicians’ day-to-day workflow,” David Chou, chief information and digital officer at Children’s Mercy, said in a statement. “Having a single source of data provides convenience and improves productivity. More important, it lets our practitioners spend more time focused directly on our patients and their care.” 

    The organizations will also embark on a joint education program to enable employees from different areas of each workforce to shadow one another. Cerner associates will be able to see and learn firsthand how care is delivered at the bedside. Caregivers can go behind the scenes to participate in the development of new technology. The collaboration aims to speed innovation within each organization and across healthcare.

    Cerner will also have a team embedded at Children’s Mercy, who will work to maximize technology’s impact on patient care by leveraging the expertise of both organizations in the exam room. 

    Children’s Mercy will implement Cerner’s full suite of solutions, based on Cerner Millennium EHR architecture, the organizations said.

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    Nurses’ value can hardly be overstated, and one of the ways they demonstrate that value is through the use of health IT. From documentation to predictive analytics and telehealth, the combination of nursing and technology is an ever-more important facet of the healthcare landscape.

    On March 5, the HIMSS18 conference in Las Vegas will feature a Nursing Informatics Symposium exploring that very topic. Six sessions, from 8:15 a.m. to 4:15 p.m., will cover how documentation can reduce clinician burden; how nurses can use predictive analytics to drive value; and how to manage a cyberattack from an operational perspective.

    Jane Englebright, chief nursing executive, patient safety officer and senior vice president of HCA, will kick things off with an 8:15 session focused on nursing documentation; she’ll make the case for the operational value of cleaning up documents, and explore the value of organizing nursing data in a standard format.

    Nancee Hofmeister, senior vice president and chief nursing officer at Evergreen Health, and Whende Carroll, director of nursing informatics at KenSci Inc., will delve into analytics, defining what predictive analytics are and outlining what nursing’s role should be. They’ll also explore how nurses can use predictive analytics to drive value.

    United States Deputy Surgeon General RADM Sylvia Trent-Adams will bring the symposium to a close, discussing the use of health data in disaster relief, and outlining the role nurse leaders have in improving public health.

    Other speakers on the schedule include UMMC Center for Telehealth Executive Director Michael Adcock, Boston Children’s Chief Nursing Officer Laura Wood, CNIO Sara Gibbons and CIO Daniel Nigrin, MD, as well as New York Presbyterian Hospital Director of Informatics Strategy Victoria Tiase.

    The “HIMSS18 Nursing Informatics Symposium: Demonstrating Nursing Value through Health IT,” takes place on March 5 in the Venetian Convention Center, Marcello 4401.

    Click here for more information or to register.

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