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- 02/12/18--06:43: _Allscripts to show ...
- 02/13/18--06:44: _Change Healthcare C...
- 02/13/18--08:00: _Trump earmarks $1.2...
- 02/13/18--08:41: _What Trump's budget...
- 02/14/18--06:31: _How do you manage d...
- 02/15/18--07:32: _Flu season, workflo...
- 02/15/18--14:22: _Roche acquires onco...
- 02/16/18--04:23: _Guide to EHR sessio...
- 02/16/18--04:52: _Recondo to unveil A...
- 02/16/18--05:13: _Athenahealth to sho...
- 02/16/18--10:04: _House balks at $10 ...
- 02/19/18--13:41: _EHR interoperabilit...
- 02/20/18--05:49: _Digital Bridge coll...
- 02/20/18--06:40: _Vision for value-ba...
- 02/20/18--11:31: _Here's how Hartford...
- 02/21/18--08:28: _JAMA: EHRs fail to ...
- 02/21/18--11:49: _Primary care group ...
- 02/21/18--13:53: _CHIME: Improved dat...
- 02/22/18--07:35: _Cerner to integrate...
- 02/22/18--10:58: _Clinical decision s...
- 02/12/18--06:43: Allscripts to show new Microsoft Azure-powered EHR at HIMSS18
- 02/13/18--06:44: Change Healthcare CEO: Blockchain can help manage patient encounters
- 02/13/18--08:41: What Trump's budget proposal means for hospitals
- 02/15/18--14:22: Roche acquires oncology EHR company Flatiron Health for $1.9 billion
- 02/16/18--04:23: Guide to EHR sessions at HIMSS18
- 02/16/18--04:52: Recondo to unveil AI revenue cycle tool for Epic EHR at HIMSS18
- 02/16/18--05:13: Athenahealth to show new tech to ease burden on doctors at HIMSS18
- 02/16/18--10:04: House balks at $10 billion price tag for VA-Cerner EHR project
- 02/21/18--08:28: JAMA: EHRs fail to reduce administrative billing costs
- 02/22/18--10:58: Clinical decision support takes to the cloud
Allscripts partnered with Microsoft last year to design a new cloud-based EHR and it will be showing the results at HIMSS18.
"Built from the ground up natively within the Microsoft Azure cloud, it functions like an app, not a traditional EHR, and gets technology out of the way of patient care,” Allscripts CEO Paul Black said. “This is a bold imaginative new EHR, not simply a series of incremental advances on existing software."
By focusing on a user-centered design the new cloud-based EHR addresses usability and efficiency issues, Black said, and in turn, improves consumer experience because by making it more realistic for patients and care teams to interact.
"Healthcare is a constantly evolving industry and our recent acquisitions position us to deliver solutions our clients need to succeed," Black added. "Through our McKesson acquisition, we expanded Allscripts client base in U.S. hospitals and health systems and along with our solution portfolio, by providing more clients with hosting capabilities, enhancing revenue cycle management and optimizing care delivery.”
Black explained that the Practice Fusion technology rounds out its ambulatory clinical portfolio and “last mile” reach to small and rural practices treating underserved patient populations.
“The focus in EHR development was on meeting regulatory requirements, which meant users had to adapt to less-than-optimal solutions," for so many years, said Black.
That’s changing at Allscripts and rival EHR vendors, many of which are turning to their focus to innovating on top of the EHR as a platform.
"Allscripts consistently employs user-centered design principles to create solutions that make systems more intuitive, overcome workflow challenges and make EHRs smarter to give users the right information at the right time – that will continue in 2018, because we want to make life easier for clinicians," Black said.
At HIMSS18, "we look forward to sharing key findings and introducing client-facing tools," he said. Among the recent client success stories, Allscripts plans to highlight at the show is the progress made by Tennessee-based Holston Medical Group.
"HMG helped form a physician-led ACO, Qualuable Medical Professionals, and a healthcare transformation company, OnePartner, which includes a private health information exchange," said Black. "Its innovations include the Extensivist Clinic, offering acute intervention in an ambulatory setting, and piloting data-driven projects, such as increasing pneumococcal vaccination rates."
Meanwhile, Allscripts' longtime client, New York-based Northwell Health has continued to innovate its care processes by developing "an elegant Clinical Snapshot dashboard that enables clinicians to use an abundance of quality data," he said. "Using open APIs, Northwell Health designed a solution that enables clinicians to see patient event notifications within their EHR workflow, which enables better care coordination."
Black noted that the comparison between HMG (an outpatient provider based in smallish Kingsport, Tennessee) and Northwell Health (with 21 hospitals and 450 ambulatory sites, it's New York State's largest employer and cares for 8 million patients) is illustrative of Allscripts' reach.
Allscripts is in Booth 2054.
An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.
It’s been just under a year since McKesson and Change Healthcare Holdings officially established Change Healthcare as its own new health IT vendor — meaning that this year’s HIMSS conference is technically the company’s first.
Change CEO Neil de Crescenzo pointed to the company’s investments in artificial intelligence, blockchain, interoperability, patient experience and revenue cycle management as examples of the direction it’s headed in the future.
Blockchain, for instance, made a big splash at HIMSS17 last year in Orlando and in the time since Change unveiled its Intelligent Healthcare Network built using the digital ledger technology to enable claims management.
“We are concurrently exploring other Blockchain use cases, such as managing the patient encounter across the entire health system all the way through to payment,” de Crescenzo said.
Change also intends to announce at HIMSS18 the formal availability of InterQual Auto Review, after having demonstrated an early version back at HIMSS17 — when it was still operating under the McKesson brand name. InterQual Auto Review actually manifested from a partnership with the National Decision Support Company, which Change acquired in mid-January, 2018. The InterQual software pulls data from otherwise disparate sources, including EHRs, to integrate evidence-based medicine capabilities into clinician’s workflow.
On the cloud computing front, Change is working with both Google Cloud and Zebra Medical Vision to incorporate AI into its enterprise imaging workflows, he added.
Also, in mid-December of 2017, Change partnered with analytics and integration specialist Tibco Software to apply Tibco business intelligence tools into healthcare workflows.
“Everyone will be talking about innovative technologies like blockchain, artificial intelligence, machine learning, cloud computing and data analytics,” de Crescenzo said of HIMSS18. “You’ll see a lot of use cases — and a lot of hype.”
And this being Change’s first official HIMSS health IT conference, de Crescenzo has another mission in mind.
“Our top priority,” he said, “is to give attendees a clear idea of who we are.”
Change Healthcare is located in Booth 4202.
An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.
In the proposed budget from the Trump administration, the U.S. Department of Veteran Affairs would get 11.7 percent more in funding or $4.2 billion -- including $1.2 billion for the first year of its Cerner EHR project.
Calling the $1.2 billion “substantive investment for this critical initiative,” the administration said the funds would help to “facilitate a seamless transition for service members as they leave the armed forces.”
The $1.2 billion sets aside $675 million as a down payment for the contract, $412 million in infrastructure improvements and $120 million for project management.
The Trump administration proposes $83.1 billion for the VA -- or $8.2 billion more than in 2017. The $4.2 billion for the agency’s Office of Information and Technology, however, is about $300 million less than FY18. About $200 million would be designated to supporting the VA’s legacy VistA and other legacy systems until the Cerner project is rolled out.
The total will also give $70.7 billion for VA healthcare, about 9.6 more from last year. Further, the funds would give veterans’ care outside of the VA health system another $13.9 billion, which includes $1.9 billion in response to the Congressional budget approved last week (H.R. 1892 (115)).
VA Secretary David Shulkin put the Cerner deal on hold in the late fall due to interoperability concerns and contracted MITRE in January to perform an assessment. Shulkin is firm on the need for interoperability, given the need for the agency to share records, not only with the Department of Defense but with those providers in the private sector.
Congressional leaders and Cerner President Zane Burke expect the deal to be signed soon.
The federal budget unveiled by President Trump includes sweeping changes to federal health agencies but also brings welcome funding in key areas.
“We’re concerned with the direction the administration is charting,” said Tom Leary, Vice President of Government Relations at HIMSS. “The agreement from last week and the President signing the budget deal doesn’t match up with the proposal they’ve submitted.”
Leary added that the proposed budget, which cuts the Department of Health and Human Services by 21 percent -- including decreasing the budgets of ONC and CDC while eliminating AHRQ -- doesn’t align with the vision Congress put forth to keep the U.S. as a leader in 21st-century health and research.
On the upside, however, he also noted that funding for cybersecurity -- up 4 percent overall and 16 percent within the Department of Veterans Affairs specifically -- is encouraging. As is the “strong down payment” Trump made on the VA’s EHR modernization plans. The proposed budget allocates $1.2 billion for the VA to implement Cerner’s EHR.
The National Institutes of Health would receive $1.4 billion more than last year, while the U.S. Food and Drug Administration’s budget would increase by $473 million.
If Trump’s budget proposal moves forward, Leary said hospital executives should anticipate that the cuts to ONC will stretch out the timelines of important initiatives like addressing information blocking, improving interoperability, EHR certification and work with states on health information exchange. Eliminating AHRQ, meanwhile, would cut funding health systems use to enhance patient safety, improve care delivery and outcomes-level research.
“The impact on hospitals is not immediate, it’s downstream,” Leary said. “We encourage Congress to take a good hard look and maintain that bipartisan focus on advancing health IT and overall health of the nation by making sure the funding for fiscal year 2019 more closely aligns with the budget deal.”
Information technologies are rapidly changing the face of medicine. But what happens when practice changes faster than documentation can keep up?
That’s a question Andrea Hall, director of clinical informatics at Shawnee Mission Medical Center, and Christina Hiatt, the Center’s clinical informatics educator, has been working hard to answer.
“We work at a facility that has an inpatient EMR and an outpatient EMR,” Hall said. “These clinics don’t really fit traditionally in either of those documentation systems, so we’ve had to come up with our own way to determine how to customize our existing things to make it work for them.”
The Center’s heart failure clinic, for instance, is located in the hospital but is designed not to manage all of a patient’s care like a traditional inpatient clinic, but to prevent readmissions, like an outpatient clinic.
“The biggest difference is the workflow that it accommodates,” Hall explained. “In the clinic you’ve got a nurse or medical assistant that comes in and sees you or a provider that comes in and sees you; it’s a single encounter and you’re discharged. It’s generally customized to meet meaningful use and documentation requirements for that setting. With inpatient, we’re looking at longer lengths of stay and just a workflow of continuous documentation throughout your stay. You’ve got more consultants and more people there.”
Hiatt said there are two other big considerations besides workflow: financial considerations like billing and charging and identifying the key stakeholders. She and Hall advocate creating a flexible system, that can work for different kinds of clinics, rather than trying to create a new documentation system for each clinic.
“I think we’re limited, we can’t have 25 boutique solutions in here,” she said. “We’ve kind of committed to an inpatient EMR and an outpatient EMR. We need to keep our information easily visible, available through all of our continuums of care. So how can we tailor our existing systems to something they’re not designed to accommodate?”
Hall and Hiatt said answering that can be tricky because three different clinics might require three slightly different solutions.
Andrea Hall and Christina Hiatt will be speaking in the session, “Navigating the Grey Areas: Outpatient/Inpatient Hybrids,” at 1 p.m. March 8 in the Venetian, Palazzo L.
An inside look at the innovation, education, technology, networking and key events at the HIMSS18 global conference in Las Vegas.
The Phoenix-based 28-hospital health system is working to move two Tucson academic medical centers it acquired in 2015 from the University of Arizona to Cerner’s electronic health record platform. While Banner Health is a Cerner shop, the two academic centers had operated on an Epic software.
Banner Health spokeswoman Jennifer Ruble said the recent EMR transition for the Tucson hospitals and clinics had been challenging.
“Workflow issues and academic practice complexity are two primary concerns that we continue to manage,” she said. “These issues were amplified by a severe flu season earlier in the year and the large scale of this change process.”
As a result, Ruble noted patients had experienced related delays, “and we regret that very much,” she said. “The Arizona Department of Health Services surveyed us related to these concerns in December. That survey closed on Jan. 22. We remain highly focused on solutions, and are making constant and steady improvement.”
The Tucson centers went live on Cerner on Oct. 1, 2017 and officials had expected to complete the move by 2018.
Pharma giant Roche is set to acquire oncology EHR software firm Flatiron Health in the first half of 2018, the companies announced today in a statement. Roche will pay an additional $1.9 billion over the millions it had already invested into the company in 2016, and as a result of the deal will control all shares of Flatiron Health.
“This is an important step in our personalized healthcare strategy for Roche, as we believe that regulatory-grade real-world evidence is a key ingredient to accelerate the development of, and access to, new cancer treatments,” Roche Pharmaceuticals CEO Daniel O’Day said in the statement. “As a leading technology company in oncology, Flatiron Health is best positioned to provide the technology and data analytics infrastructure needed not only for Roche, but for oncology research and development efforts across the entire industry. A key principle of this is to preserve Flatiron’s autonomy and their ability to continue providing their services to all existing and future partners.”
New York-based Flatiron Health was founded in 2012 by former Google employees Nat Turner, CEO, and Zach Weinberg, president and COO, both of whom told the New York Times in 2016 that they planned to take the company public in two or three years. At that time the company — which had also enjoyed major investments from Alphabet’s GV — was valued at $1.2 billion.
Flatiron Health offers an oncology-specific EHR platform employed by both community oncology practices and academic medical centers within the US. In addition, the company has also developed a suite of software products that employ real-world data from these records to uncover cancer research and care insights.
“Roche has been a tremendous partner to us over the past two years and shares our vision for building a learning healthcare platform in oncology ultimately designed to improve the lives of cancer patients,” Flatiron Health cofounder and CEO Nat Turner said in a statement. “This important milestone will allow us to increase our investments in our provider-facing technology and services platform, as well as our evidence-generation platform, which will remain available to the entire healthcare industry.”
The companies noted in the announcement — and confirmed to CNBC — that Flatiron Health will continue its current business model and other operations as a separate legal entity.
Whether you are consolidating multiple systems into one enterprise electronic health record, integrating various vendors products or optimizing an existing EHR, there are many HIMSS18 sessions to pick from.
There are, in fact, far too many sessions about EHRs to include them all here, so this is a roundup of highlights focused on making the most of your EHR at this year’s health IT conference.
Optimizing Care Transitions Across the Continuum
Experts from a large teaching hospital will share their two-fold strategy to ensure transitions are effective and safe. The work included establishing a centralized call center for post-discharge follow up and streamlining EHR workflows to increase staff productivity. The end result: Better care for patients after they’ve been discharged.
Speakers: Victoria Chestnut, Manager, Integrated Population Health, Lehigh Valley Health Network; James Shull, IS Project Manager, Lehigh Valley Health Network
When: 10-11 a.m. March 6
Where: Sands Showroom
Developing a Strategy to Manage Legacy Data
Speakers in this session will address data archiving, migration and retention project St. Luke’s undertook to standardize onto a single EHR and how it developed the strategy, including a look at determining what information to retain and evaluating archiving solutions.
Speakers: Cindy Andreason, Director, Health Information Management, St. Luke's Health System; Keith Olenik, Principal, The Olenik Consulting Group, LLC
When: 11:30 a.m. - 12:30 p.m. March 6
Where: Venetian Galileo 901
Closing the Gap: Risk Insights at the Point of Care
Officials from a physician-led ACO will share lessons learned from maintaining an accurate understanding of patient risk to inform decisions about creating care programs while ensuring reimbursement, and how to add HCC coding gaps directly into the EHR helped it succeed.
Speakers: Heather Trafton, Vice President of Operations, Steward Health Care Network; Catherine Turbett, Director, Practice Performance Improvement, Steward Health Care Network
When: 1-2 p.m. March 6
Where: Venetian Galileo 901
The Value of the Clinical Narrative in Cancer Care
MD Anderson and Nuance will shed light on adding intelligent speech technologies to the EHR to illustrate the value of storytelling and incorporating the patient narrative in cancer care.
Speakers: Jerry Henderson, Associate Chief Medical Information Officer, MD Anderson Cancer Center; Michael Clark, Senior Vice President, General Manager, Nuance Communications
When: 1-2 p.m. March 6
Where: Venetian Palazzo K
Optimizing EHR Governance to Improve the User Experience
Dignity Health began standardizing its EHR governance to optimize the user experience in 2014 and has since achieved increased throughput, decreased turnaround times as well as improved provider engagement and satisfaction. The speaker will discuss processes developed and lessons learned along the way.
Speaker: Paula Scariati, Medical Director, Health Informatics, Dignity Health
When: 2:30-3:30 p.m. March 6
Where: Venetian Galileo 901
Using Simulation Training to Speed EHR Adoption
This look at how MD Anderson used simulation training to augment classroom work for more than 2,000 providers as it geared up to go-live with a new EHR – a project that was seen as extremely valuable when they surveyed participants after the program. This session will include advice about preparing and scaling simulation training.
Speakers: John Frenzel, Chief Medical Information Officer, MD Anderson Cancer Center; Craig Owen, Executive Director, MD Anderson Cancer Center
Where: 4-5 p.m. March 6
When: Venetian Murano 3304
Clinical Process Improvement for Scalable Quality Governance
When Tampa General Hospital embarked on clinical process improvement (CPI) to enhance standardization and efficacy of treatment for high-priority conditions, it designed the program to be scalable and repeatable. This session will outline that strategy, discuss its success with sepsis, and explain the organizational changes that came about.
Speaker: Peter Chang, Chief Medical Informatics Officer, Tampa General Hospital
When: 4-5 p.m. March 7
Where: Las Vegas - Venetian Convention Center, Murano 3301
Pharmacogenomics Within the EHR
The National Institutes of Health Clinical Center implemented a pharmacogenomics program within its EHR that consists of genotyping clinical decision support. Leaders from the NIH Clinical Center will discuss the clinical, laboratory, informatics, and policy decisions involved in making that implementation happen.
Speakers: Jon McKeeby, Chief Information Officer, NIH Clinical Center; Jharana Patel, Chief Pharmacy Information Officer, NIH Clinical Center
When: 2:30-3:30 p.m. March 8
Where: Venetian Delfino 4002
From Implementation to Optimization: Moving Beyond Operations
The speaker will address the need to evolve hospitals’ when it comes to maintaining long-term operational support for EHRs, including evaluating governance, processes and structures and will share insights about optimizing the work intake, enhancing clinical partnerships, prioritization, and developing key performance indicators and service level agreements.
Speakers: Scott Aikey, Senior Director, Core Clinical Application Support, Children's Hospital of Philadelphia
When: 2:30-3:30 p.m, March 8
Where: Venetian Marcello 4405
Achieving HIMSS Stage 7: Realizing the Benefits of Your EHR
Hilo Medical Center CIO and EHR Director will share their journey to HIMSS Stage 7 and what goes in recertification. The discussion will include a look at key metrics for qualifying, the importance of using its EHR to full potential and it will also involve insights to help others discover whether they are doing more than they might think to improve patient care.
Speakers: Kris Wilson, Chief Information Officer, Hilo Medical Center; Christine Takahashi, EHR Director, Hilo Medical Center
When: 4-5 p.m. March 8
Where: Venetian Palazzo K
Improving Health IT Through Use of NLP/AI in Documentation
Speakers will share evaluation strategies for incorporating a voice-generated electronic note system and natural language processing (NLP) technologies with an EHR to improve accuracy, timeliness, and patient safety.
Speakers: Li Zhou, Associate Professor; Lead Investigator, Harvard Medical School; Brigham and Women's Hospital; Suzanne Blackley, Associate Application Analyst, Partners HealthCare
When: 10:30-11:30 a.m. March 9
Where: Venetian Galileo 904
Recondo Technology plans to announce at HIMSS18 a new revenue cycle management tool that uses artificial intelligence to leverage Epic’s electronic health record to reduce the risk of denials and increase collections at the point of service.
The Recondo automated RCM platform for Epic capabilities include: patient demographic verification, real-time eligibility and authorization, benefits normalization alerts management for denial risk reduction, and it and features Recondo's ReconBot technology for authorization initiation and follow-up.
Recondo said that based on sample data from live customers, the platform helps hospitals to increase revenue prior to service, reduced money lost to denied claims and drove productivity savings.
While the version the company is showing at HIMSS18 runs on Epic, Recondo CEO Jay Deady said it will expand that to other platforms in the future.
"Customers can expect three major themes in future releases: continued expansion to other prominent EMR systems, the launch of machine learning to drive actionable intelligence for front-line revenue cycle staff, and integration with new market disruptors as needed to deliver more value to our clients," Deady said.
Recondo is in Booth LR11.
At HIMSS18, athenahealth will be demonstrating new offerings designed to address a range of pain points physicians face today.
The company will introduce a new provider-facing mobile app, for instance, that it bills as untethering providers from their desktops and enhances connectivity across the healthcare ecosystem. “This goes so much further than the average ‘virtual assistant’ in healthcare," athenahealth CEO Jonathan Bush said.
Bush added that the goal is to take away the grunt work doctors often have to do – such as dealing with claims, faxes, document services, denials, authorization management – and more.
As Bush sees it, that’s work that no physician really wants to do or has been schooled to do. Moreover, it’s work that most contributes to the industry’s growing burnout epidemic.
The past year turned out to be an interesting one for athenahealth, which was forced to tighten its belt, layoff staffers and shutter some locations while an activist investor acquired nearly 10 percent of the company’s stock.
During the time, Bush noted, athenahealth has transitioned to an agile development culture – putting in place methodology designed to foster a more fluid approach to product development and innovation.
Bush said athenahealth has also made headway with its efforts to free providers to focus on what matters most.
“Instead of annual assessments, tactical plans are reviewed in 1-2 week increments, allowing us to work faster, course-correct quickly, and show regular, demonstrable progress,” he explained. “Our clients reap the benefits of this approach as we continue to open up our network, build connectivity, and work toward a platform experience that has never existed before in healthcare.”
In addition to the technologies, athenahealth will be showing at its booth, Bush is scheduled to participate alongside Jefferson Health CEO Stephen Klasko, MD in a session titled “Physician Engagement as a Catalyst for Clinical and Financial Improvement,” set for Thursday, March 8, at 4 p.m. in the Venetian Palazzo G.
Athenahealth is in Booth 119.
As the time draws near for the U.S. Department of Veterans Affairs to sign its EHR contract with Cerner, Congressional members are growing increasingly concerned over not only the $10 billion price tag, but that the agency will need to keep the legacy system in place, perhaps indefinitely.
“While the EHR modernization effort is necessary, it is very expensive,” House VA Committee Chairman Phil Roe, MD, R-Tennessee, said during the Thursday hearing on the VA’s 2019 budget requests.
“The contract with Cerner alone has a price tag of about $10 billion and that doesn’t even include the costs of updating infrastructure to accommodate the new EHR, implementation support or sustaining VistA up until the day it can be turned off,” he continued.
In fact, Roe is concerned that the VA’s legacy EHR may never be completely gone.
“After visiting Fairchild Air Force Base in Spokane, Washington, recently, I’m not even sure you can ever turn VistA off,” Roe said.
President Donald Trump released his proposed FY19 budget this week, which earmarked $1.2 billion to get the project with Cerner off the ground. VA Secretary David Shulkin, MD, put the potential Cerner contract on hold in January, pending an independent review of Cerner’s interoperability capabilities.
While Roe applauded Shulkin’s move to ensure interoperability, he’s still not certain the project can be successful.
“It’s unthinkable that VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with the Department of Defense or community providers,” Roe said. “But that’s exactly what could happen if VA fails to proceed in a careful deliberate manner.”
In response, Shulkin stressed that the agency is taking the modernization very seriously.
“We have to make sure that we can be interoperable with dozens of different health systems out there,” said Shulkin. “And that’s a challenge that frankly the American healthcare system hasn’t figured out yet... We think VA can help lead this for the whole country by making this interoperable.”
Shulkin recognized the agency’s track record of failed IT projects – the Government Accountability Office recently reported that the VA likely wasted at least $1.1 billion on multiple EHR modernization attempts – and understands that this EHR replacement must work.
Given the size and scope of the project – there are more than 130 versions of VistA operating right now – Shulkin said the legacy system will need to be maintained over a 10-year implementation period.
To account for that, Shulkin is requesting Congress provide the VA a separate account to fund the project. The account would provide the VA with the necessary funds for maintaining VistA and implementing the Cerner EHR, and would provide transparency to where those funds are going.
The VA is expected to sign the Cerner contract in the next few weeks, after the vendor reportedly passed its independent assessment.
Ninety percent of healthcare professionals participating in a new survey confessed to being confused about what makes a highly interoperable EHR. Black Book Research, in fact, surveyed 11,838 doctors, healthcare administrators, technology managers and clinical leaders around the world.
What’s more, 72 percent stated that their preferred strategy for EHRs is to link disparate systems through messaging, APIs, web services and clinical portals -- but only seven percent of all international EHR survey respondents described their regional HIT system as having meaningful connectivity with other providers.
That’s at least part of the reason why Black Book in its new “State of the Global EHR Industry, 2018” report predicted a pending shift from silo EHR systems toward regions of healthcare delivery organizations in Europe, the Middle East and South Asia. Respondents to the survey anticipate a move to enterprise-wide electronic health records systems with data exchange and care coordination capabilities similar to the global offerings of current U.S.-based vendors by 2023.
"A number of countries have launched national initiatives to develop ICT-based health solutions including EHR systems and have progressed well, despite several hurdles," Black Book managing partner Doug Brown said in a statement. "As the obstacles are clearing with technological and non-technological interventions, approved standards and regulatory frameworks, funding and health-tech guidelines, the growth opportunities for U.S.-based global EHR vendors magnify as well."
Eighty-three percent of EHR users in Europe outside the United Kingdom indicated frustration with country-specific and local vendors that typically serve only one country with limited components, such as coding, scheduling and results reporting.
Of those clients, 72 percent said system limitations would prompt them to replace their local or country-specific EHR with a global vendor product.
"The global healthcare sector is undergoing a wave of transformation, with digitization being the core focus area," Brown added. "Healthcare IT products, services and systems are in high demand in nations significantly upgrading their healthcare infrastructures such as Singapore, Israel, Japan and Italy, as well as infrastructure-generating nations of India, China, Brazil, Qatar and Indonesia."
This investment on technology infrastructure for healthcare is expected to spark the double-digit growth of the EHR market spend in these specific regions through 2026, according to Brown, while spending on EHRs is expected to top $25.1 billion U.S. in 2017 and continue to grow to more than $30.2 billion by 2020.
Digital Bridge, a collaboration among healthcare, public health and health information technology organizations, works on the premise that improving information sharing can improve the nation’s health.
To that end, the collaborative has designed an approach to electronic case reporting, or eCR, that is being rolled out in states and cities across the country. The goal is for eCR to improve public health surveillance of infectious diseases, which in turn would lessen the burden on providers for meeting public health reporting requirements.
Digital Bridge is intended to promote partnerships that improve data for public health and clinical practices and also lower costs for information sharing. As such, the effort entails streamlining interoperability between EHR systems and the IT systems public health agencies use to monitor disease trends and respond to outbreaks, said Jim Jellison, Director of Practice Support at the Public Health Informatics Institute. “Our current focus is on automating the public health reporting process for infectious diseases.”
One of the barriers to eCR, Jellison said, is the fact that infectious disease reporting is regulated at state and local jurisdictional levels, which means case reporting criteria can vary from state to state making it difficult for providers and IT developers that operate across state boundaries.
There is good news on this score, however. Public health stakeholders are harmonizing case reporting data requirements on a new HL7 standard for eCR and building a decision support platform that mitigates the variation in state reporting requirements, Jellison said.
The Centers for Disease Control and Prevention, Association of Public Health Laboratories, and Council of State and Territorial Epidemiologists have led the development of these tools. Robert Wood Johnson Foundation, Deloitte and the de Beaumont Foundation are funders.
Health IT vendors Cerner, Epic, and NetSmart are beginning to implement them now in collaboration with their clients. Allscripts, Meditech and eClinicalWorks also participate in the Digital Bridge and are helping develop an eCR approach that can be adopted nationwide.
Jim Jellison and Jeff Livesay will be speaking in the session, “Population Health Information Exchange Over a Digital Bridge,” at 1 p.m. March 8 in the Venetian, Delfino 4002.
Healthcare recognizes the role that evidence-based medicine plays in improving outcomes and lowering costs. The use of clinical decision support tools incorporating evidence-based medicine at the point of care provides physicians with access to translational research and current recommendations.
Kaiser Permanente recently completed a large-scale, electronic health record-based integration of clinical decision support tools including access to predictive analytics, a prescription formulary, treatment algorithms and evidence-based disability guidelines.
“Integrating evidence-based decision tools at Kaiser involved planning and multiple stages of implementation,” said Kurt Hegmann, MD, director of the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah and a Kaiser partner. “Engagement with all stakeholders including physicians, IT and administrators was essential for success. All implementation steps were important to be able to improve value and the quality of healthcare.”
The road to real, meaningful evidence-based medicine is a long and iterative process that requires vision from the CEO level, identification of useful and real evidence-based medicine tools and not mere lookalikes, implementation, problem-solving, and continuous improvement, Hegmann added.
To peers working in evidence-based medicine and clinical decision support, Hegmann offers hard-won advice.
“Have a vision and plan for developing value-based care that includes evidence-based medicine tools adoption, implementation, and continuous quality improvement,” he said. “And expect to have to adjust the plan while not losing focus.
Overall, there is a nascent trend toward value-based care that arose from prior quality improvement efforts. IT tools are providing the means to achieve what previously was challenging on paper
“The day where reimbursement is largely or totally value-driven based on insurer/business/CMS-based requirements is likely quite near, and being unprepared for these changes could be organizationally fatal yet proactively avoidable,” Hegmann said.
Hegmann will be speaking in the session, “Integrating evidence-based decision tools within an EHR,” at 8:30 a.m March 8 in the Venetian, Murano 3304.
Hartford Health is a large health system serving the greater central Connecticut area. Last June, state lawmakers passed legislation mandating the use of electronic prescribing for opioid medications and other controlled substances. Jan. 1, 2018, deadline meant Hartford Health had less than six months to implement a system.
"It was a huge project for us," said Spencer Erman, MD, chief medical information officer at Hartford Health. "We decided to partner with Imprivata to implement the technology. They worked with us to install all the hardware and software we needed, and helped get our physicians registered in time to meet state requirements."
The system now is being used by a variety of providers in every hospital, ambulatory care center and outpatient surgery center in the health system. Providers are using it at home, as well. Basically, any place a provider can sign into the health system's Epic EHR, he or she can use EPCS.
"As for devices, with Imprivata's Confirm ID platform, you have a choice of what to use," Erman explained. "It could be a key fob, fingerprint scanner or smartphone app. Most of our providers decided to go with the smartphone app, which works on Apple or Android phones. A handful of our providers are using fingerprint scanners, and we hope to add more in the future when our budget allows."
Once a physician is registered in the system, if he or she is on the hospital Wi-Fi, they enter an electronic prescription, enter their password, and an instant message appears on the screen of their phone that says, "Do you approve this medication?" They swipe it and they're done.
Electronic prescriptions solve a key issue when it comes to battling the opioid epidemic: They get paper prescriptions off the street. That has always been a problem because people alter paper prescriptions, they steal prescription pads and forge their own prescriptions, all sorts of mischief.
"There is very little paper changing hands, which means the DEA number is no longer out there, the license numbers aren't out there. Forged and altered prescriptions have greatly decreased, if not disappeared."
Spencer Erman, MD, Hartford Health
"That's all gone now because there is very little paper changing hands, which means the DEA number is no longer out there, the license numbers aren't out there," Erman said. "So, forged and altered prescriptions have greatly decreased, if not disappeared."
Imprivata is just one of many players in the electronic prescribing software market. Other players include Allscripts, athenahealth, DoseSpot, DrFirst, HBS Pharmacy, MD Toolbox, NextGen Healthcare, PioneerRx, Practice Fusion, RxNT and Surescripts.
With its e-prescribing system, anything Hartford Health prescribes now automatically goes into the Connecticut PMP. In the past, it might take hours or days for a pharmacy benefit manager to manually enter prescription information into the system. Now it is sent in near-real time. That helps prevent doctor shopping because people can't go to three doctors within two hours and get multiple prescriptions. It also allows for a complete state database and makes it easy to track who writes what.
"In addition, EPCS helps doctors limit the amount of medication they prescribe," Erman explained. "In the past, we might give patients 7-10 days' worth of pills to avoid the hassle of having them physically come back for another paper prescription.
"Now we can just give two to three days' worth and send a new prescription electronically to people who legitimately need more medicine. It is convenient for patients and limits the number of pills out on the streets or sitting unused in medicine cabinets," he said.
Hartford Health learned a number of lessons along the way to getting up and running with e-prescribing and can share those lessons with peers.
"The most time-consuming step was what's called ID proofing: Registering all our prescribers with Imprivata software to ensure access to the system," Erman said. "We had 4,000 providers and just over 2,000 prescribed controlled substances in the past year. So, we had to register 2,000 providers in a couple of weeks."
The registration itself isn't difficult, Erman added. Prescribers show their hospital ID and one form of government ID. Qualified personnel enters data into the system. Finally, they sync the smartphone app in Epic. It takes about five minutes total per provider.
"To meet our deadline, we made sure we had a lot of people with clearance to do the ID proofing," Erman said. "We set up kiosks in all the hospitals and went to every department meeting possible to get everyone enrolled. But we used the time with providers to fill other needs as well."
For example, Hartford Health was installing Single Sign-On (a badge tap), so the health system went ahead and registered everyone for that at the same time. It also registered everyone's fingerprint while it had them because it plans on rolling out fingerprint scanners across the health system at some point in the near future.
On another front, one tip Erman would offer others planning to implement EPCS is to have a plan for entering pharmacy information.
"You need to have a favorite pharmacy within Epic and that's not always done," Erman said. "A patient coming through the emergency department isn't necessarily going to have a pharmacy of choice registered in the EHR. But you have to enter one for EPCS.
"The challenge is not everyone has the proper clearances or credentials to enter that field, at least within Epic. What we did was create a drop-down menu which makes it simple for doctors and nurses to enter a pharmacy. That approach worked well."
One of the core reasons the federal government made its push for the adoption of electronic health records was that it would reduce administrative costs. But a new study published this week in the Journal of the American Medical Association found EHRs aren’t getting the job done.
Researchers from Harvard Business School and Duke University examined the use of a certified EHR at a large academic healthcare system, which found estimated costs for billing and insurance-related functions were substantial and varied by the type of clinical encounter.
The team looked at five different patient encounters: discharged emergency department visits, primary care visits, ambulatory surgical procedures, general medicine inpatient stays and inpatient surgical procedures.
The administrative costs accounted for at least one-quarter of professional revenue for certain patient encounters, which researchers said were caused by varying contracts between hospitals and plans, in addition to variants in price schedules.
Costs of billing and insurance-related functions ranged from as low as 13 minutes or $20 per primary care visit to 100 minutes or approximately $215 for an inpatient surgical procedure. That’s about 3 percent to 25 percent of professional revenue, according to the study.
Discharged ER visits cost providers 32 minutes or about $61 and both general inpatient stays and ambulatory surgical procedures cost about 73 to 75 minutes or around $124 to $170, the researchers found.
Overall, the study estimated billing costs for primary care services are about $100,000 per provider, annually.
“We found no evidence that adoption of these expensive EHR systems reduced billing costs related to physician services,” Kevin Schulman, MD, of Duke Clinical Research Institute and Harvard Business School and one of the study’s authors, said in a statement.
To Harvard Business School’s Robert S. Kaplan, co-author of the study, the high billing costs found in the study weren’t caused by wasteful or inefficient processes or “inappropriate use of high-wage personnel to perform low-skilled tasks,” as the health system had streamlined bill-paying functions.
Instead, researchers found high costs associated with EHRs “are the consequences of heterogeneous payment requirements across the multiple payers and health plans contracting with the academic health center.”
Further, in an accompanying editorial, researchers explain that as high as the figures were for this specific health system, the reality is the financial burden will likely be higher for other healthcare providers. The studied health system and physicians share the same billing system, which is not the norm for other organizations.
“We need to understand better how complexity is driving these enormous costs within the system, costs that do not add value to patients, employers or providers,” study co-author Barak Richman of the Duke-Margolis Center for Health Policy said in a statement.
“We hope that this work is the first step toward informing policy solutions that could reduce these non-value-added costs largely hidden within the healthcare system,” said Schulman.
Georgia's Albany Area Primary Health Care is working on population health, focusing on what the provider organization believes to be high priority conditions that will add value to the practice, to patients and to payers.
The healthcare organization has a major effort underway in colorectal cancer screening, trying to significantly increase its screening rates. It is doing a breast and cervical program at the CDC, applying it to uninsured women, many of whom would never have a mammogram. And it's doing another program to try to increase its pneumococcal vaccination rates, doing this in affiliation with the American College of Physicians and the CDC. Those organizations have a program that Albany Area Primary Health Care is sustaining for hypertension control.
The colorectal program is a major focus, and technology has played a big part in its success, said James Hotz, MD, clinical service director at AAPHC. He said its technology allows a user to analyze what the electronic health record shows is done and what's not done: The user can easily click by site or by a clinician, and the system presents a green bar (meaning done) or a red bar (meaning not done).
"So we would click on the red bar for people coming in that week, and our population managers would post it as ordering FIT (fecal immunochemical test) or colon cancer screening as something to be done," Hotz explained. "They would then do a focused outreach to people who may not be coming in anytime soon. What we found is 20 percent of the people that needed to be screened didn't even have a return appointment."
So the population managers did a mail campaign including a FIT test to all those who were at average risk. They call them at day two and day seven to encourage people to return the FIT test. The clinics that employed population managers each achieved above 75 percent screening rate, with one hitting above 80 percent.
"In the clinics where we did not do this focus application of population managers, numbers were running down into 40 percent to 50 percent," Hotz said. "But globally, by doing this focused outreach using this analytics technology, we've been able to increase our screening rate significantly. When we started the project, and this was January of 2016, we had a 34 percent colorectal cancer screening rate. Today our rate is 60 percent."
Some basic math at the clinics: One in 20 people unscreened over 50 will develop colon cancer and that means that, with their numbers, there were 125 people who would have developed colon cancer.
"By screening, we reduced that risk of colon cancer by 70 percent, so that's 87 people who we can prevent getting colon cancer by increasing these rates," Hotz said. "So it translates into good quality metrics but it translates into lives saved."
Albany Area Primary Health Care uses population health technology from Forward Health Group. Many vendors provide population health systems, including The Advisory Board, Caradigm, Enli Health Intelligence, Evolent Valence, IBM Watson Health, Optum and Wellcentive, as well as EHR vendors Allscripts, Cerner and Epic.
Hotz added that the organization also uses the population health technology to generate various payer-oriented reports.
"A lot of times we find out there's some errors in reports, like we are not capturing hysterectomies that have been done and there all those denominators and they are falsely lowering our cervical cancer screening rates," Hotz explained. "But the real bottom line to administrators is, on all UDS measures that are part of this portfolio or population management, we are significantly above national average. And what that meant to us from just HRSA alone was like $287,000 of quality bonus for us last year."
Measuring quality, Albany Area Primary Health Care comes out quite high, which helps with value-based care, and Hotz credits the population health program and technology for this high quality.
"Look at the numbers," Hotz said. "All clinics nationally for tobacco screening are at 85 percent versus our 90 percent, colorectal 39 versus 60, for coronary disease and limpid management 79 versus 90, ischemic vascular 78 versus 90, controlling high blood pressure 62 versus 73. So when you compare us to all the federal qualified health centers, our performance is above national average on all of them and that's where, depending on the quartile you'll fit in, that helps determine part of your bonus."
Hotz added that this not only helps with quality patient care and payment bonuses, it helps with employee recruiting and other matters.
"It's easier to recruit a five-star college football player to Alabama than it is to Vanderbilt because, you know, people want to be on the winning team," Hotz concluded.
Technology and data are crucial to limiting the impact of the opioid epidemic, but some congressional mandates may hinder the cause, according to a letter from CHIME to lawmakers.
The Senate Finance Committee is examining potential policies that could improve care access and treatment quality, in addition to addressing the causes that lead to abuse. Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Oregon, called on the healthcare industry earlier this month to provide feedback.
In response, CHIME highlighted recommendations and challenges to curtailing the spread of the opioid epidemic by answering three of the committee’s questions.
First, interoperability is a major roadblock to the data sharing capabilities necessary for care coordination between state initiatives like Prescription Drug Monitoring Programs. And CHIME said part of that problem is caused by the lack of a consistent patient identity matching strategy.
“We continue to recommend the removal of the prohibition barring federal regulators from identifying standards to improve positive patient identification,” CHIME CEO and President Russell Branzell and Board Chair Cletis Earle wrote. “Without a consistent patient identity matching strategy, the creation of a longitudinal care record is simply not feasible.”
And a longitudinal health record will also improve the ability for patients to monitor consent and reduce privacy concerns for digital health information.
Data access also needs to be seamless and streamlined for providers, especially for use with PDMPs. However, CHIME contends that challenges with integrating EHRs with PDMPs are hindering that capability.
For example, some states restrict access to prescribing data. Some providers can see the data but can’t share it with other providers or even take a screenshot.
“Removing restrictions around sharing information contained in PDMPs is critical to quality care,” wrote Branzell and Earle. To the group, this also means targeting state governance to remove barriers at the local level, or “prescribers will continue to have an incomplete picture of a patient.”
CHIME also provided recommendations on how Medicare and Medicaid can better prevent, identify and educate health professionals with high-prescribing patterns of opioids. The group stressed the need for better EHR-PDMP integration, combined with data-driven reports to identify prescribing patterns.
Further, clinical decision support should be leveraged to offer evidence-based treatment, Branzell and Earle wrote. The group said it will help providers find appropriate treatments that may or may not include prescribing opioids. The tool can also provide prescribing guidelines.
“CDS is one piece of the EHRs,” Branzell and Earle wrote. “These systems overall need to be able to better support a more holistic approach to managing and treating addiction as a disease.”
Further, CHIME stressed the need for harmonization of state and federal policies, such as consent policies. The group noted that there is currently no national consent policy.
CHIME has made an active effort to join the response to the opioid epidemic. The group launched an opioid task force in early February in hopes to rally chief information officers to join the effort. The task force held its first meeting shortly after with about 24 attendees and is working on creating broader participation among its 2,500 members.
Cerner announced a new collaboration with Surescripts to integrate real-time prescription benefit functionality into its Cerner Millennium EHR.
The companies said that including the Surescripts Real-Time Prescription Benefit into the EHR’s physician workflow will provide patient-specific prescriptions at the point of care.
When doctors can access patient-specific prescription pricing as a part of their workflow, it makes for a better medical decision between the doctor and the patient, Surescripts Chief Product Officer Mike Prittis said in a statement. It’s also a huge step toward improving medical adherence, he added. Moreover, it sparks engagement between doctor and patient.
Cerner Millennium provides prescription price transparency by extracting information from pharmacy benefit managers.
Having that functionality embedded in the EHR makes it easier for doctor and patient to work as a team to create a medical plan that patients can afford and follow, Cerner President Zane Burke added.
Cerner expects to have the new functionality online in March 2018.
The era of value-based care demands the smart use of clinical decision support. With quality improvement now an imperative, CDS is crucial to help health systems move the needle on more effective care delivery.
Ideally, CDS tools will be readily accessible to a wide array of caregivers where and when they need them, irrespective of what electronic health record they're using. That's easier said than done but success stories are emerging.
Take the AHRQ-funded CDS Consortium Project, for instance.
"The CDS Consortium project demonstrated successfully that CDS from Partners Healthcare could be delivered to disparate EMRs across the country," said Blackford Middleton, chief informatics and innovation officer at Apervita.
Other EHR platforms in the consortium work include Epic, NextGen, GE Centricity, two academic EMRs at the Regenstrief Institute, and Partners own EMR.
"Delivering well-vetted CDS via the cloud allows the average EMR user to avoid the problem of discovering the right CDS to do, and how to encode it into his or her EMR. Making knowledge artifacts for CDS shareable in this manner helps to deliver on the value proposition anticipated for EMR but not yet realized: fewer medical errors, improved compliance with guidelines, better outcomes, at a lower cost."
It's a complex process, said Middleton, but "with the growing availability of standards designed exactly for this purpose, it’s becoming easier to do. The 21st Century Cures Act calls for every EMR to make available an API which can be used 'without special effort.' This is a critical step to get data out of and back into EMRs. The next step is to standardize the knowledge representation and clinical quality language, or CQL, helps here immensely — we have already seen its impact on standardizing eCQM (electronic clinical quality measure) specifications.
CQL will help standardize the way knowledge elements for both quality measures and CDS are represented, he said. SMART on FHIR, meanwhile, "allows us to build an app that can work inside or outside of the EMR to provide extra functionality. This can be special rich data displays, interactive sessions with the clinician (or patient) to gather information not in the EMR, or problem-focused special clinical documentation tools fitting into the clinical workflow."
Middleton added: "We strongly believe this is the way to go – it will be impossible for every EMR implementation to rediscover and implement the world’s best knowledge so it is imperative we share it across multiple EMRs in this way. We hope this leads to 'best care everywhere.'"
At HIMSS18, Middleton and Ninad Mishra, health scientist at the U.S. Centers for Disease Control and Prevention, will show how cloud infrastructure can help.
Middleton and Mishra will describe how collaborative web-services and standards-based APIs can deliver CDS an outpatient encounter, spotlighting the current state of the technology and exploring the prospects for the future evolution of standards harmonization and vendor support.
The session will show how the Apervita platform can encode complex clinical logic and express it in various online tools and apps, explaining how it can be implemented in the cloud and securely accessed via EHRs nationwide.
Middleton and Mishra are scheduled to present, "CDS in the Cloud: Deploying a CDC Guideline for National Use," at 1 p.m. March 8 in Venetian Murano 3304.