Healthcare IT company Allscripts and rideshare provider Lyft have partnered to provide non-emergency transportation for people who need to get to medical appointments, the companies announced Monday at HIMSS18.

Leveraging Lyft’s proprietary application and Allscripts’ Open platform, they plan to integrate the functionality into Allscripts Sunrise EHR to enable clinicians to order the Lyft service for patients.

“Health IT should always put the patient first and seize every opportunity to help improve patients’ access to care,” Allscripts CEO Paul Black said in a statement.

[Also: Uber offers providers, patients new Uber Health transportation app and dashboard]

By leveraging a Lyft-developed API and Allscripts open platform, the functionally enable clinicians and ancillary staff to order the Lyft service for patients through an automated workflow, he added.

On the day of the appointment, clinicians will receive real-time updates through Sunrise EHR on the progress and ETA of the patient.

As Black sees it, the partnership speaks to Allscripts’ commitment to connecting communities and helping providers deliver the services their patients need.

Today, 3.6 million Americans have transportation issues that prevent them from getting to or from a doctor’s appointment, and 25 percent of lower-income patients have missed or rescheduled appointments due to lack of transportation. Through this partnership, Allscripts and Lyft have the potential to reach millions of Americans, in an effort to eliminate these transportation barriers and improve access to healthcare, the partners said in a statement.

Uber also recently unveiled a new app and text messaging service to get patients to and from doctor’s appointments and the hospital.

A dashboard app allows healthcare professionals to order rides for patients going to and from the care they need. An Uber Health API allows for integration into existing healthcare products, for transportation to be scheduled for follow-up appointments while still at the healthcare facility. 

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

LAS VEGAS – Healthcare is in need of a culture change when it comes to sharing data, Aneesh Chopra, president of NavHealth and former U.S. chief technology officer under President Barack Obama, said Monday at HIMSS18.

All over the world, healthcare innovators are developing new technologies and using data to help. However, this information isn’t always available for others to use. 

“In a world of unknown, it is better to bet on more shots on the goal and bring [in] ideas,” Chopra said during his opening keynote address at the HIMSS Innovation Symposium. “It is finding ways to tap into that creativity that compels us and the only way that will happen.”

Chopra drove the shift from closed to opened innovation during his stint with the Obama administration, often learning from both public and private sector approaches.

“I took from Proctor & Gamble and Facebook the notion we should provide air cover to agencies,” said Chopra. “And … to seek ideas and to open up, whenever feasible, all of our underlying assets so we could tap into this broader ecosystem of developers and innovators especially, in areas of the economy that were data rich but insights poor.”

There are already examples of healthcare innovators taking advantage of public data. One of the first data points that the government released was GPS. Louisville doctor, David Van Sickle used GPS data to measure patient inhalers. He teamed up with the city’s mayor and were able to put a GPS chip on a number of inhalers. He discovered that certain sections of the city had a disproportionate number of attacks. This allowed the city to reallocate public health resources and reduce the risk. Since then Van Sickle has commercialized the technology and founded Propeller Health. 

“Sometimes you have to create the capacity for innovation,” said Chopra. 

Chopra named Apple Health as one of the avenues to help opening up data sharing and innovation. Apple Health, which consolidates health data from iPhone sensors, Apple Watches and third-party apps, also has a toolkit component for innovators to create apps. 

But instead of keeping the Apple Health data system closed to Apple products, it can integrate data from multiple platforms. 

Apple health has recently announced that it is launching a personal health record feature that will aggregate existing patient-generated data in the Health app from users EHR if the user is from a participating hospital. 

But as healthcare looks to more data sharing, it is important for more companies to protect patient data, said Chopra. 

“As we liberate this data and move into Apple Health we have to think about our relationship to the patient,” Chopra said. “While we liberate the data we will face our own obligation to steward that data in a new Hippocratic Oath.”

Twitter: @lauralovett7
Email the writer: laura.lovett@himssmedia.com

LAS VEGAS – Healthcare CIOs have a lot to think about this year, attendees at the CHIME CIO Forum at HIMSS18 on Monday showed.

James W. Brady, Area CIO at Kaiser Permanente,  Kaiser is expanding its virtual care and also encouraging self-care where appropriate. The Oakland, California-based health system is giving consumers stethoscopes, otoscopes and dermoscopes for self-diagnosis. Kaiser is also exploring drones for medical supplies delivery and other tasks.

Arora, who is Senior Vice President, Information Services and CIO at Children's Health in Dallas said she and her team are focusing intently on taking a consumer-centric approach to patient and whole-family care. 

"As the leading pediatric health system in North Texas, everything we do at Children's Health centers on our mission to make life better for children," added Arora, who was named 2017 CIO of the Year by CHIME and HIMSS.

She noted that with the exponential population growth in the North Texas region, especially considering the number of young families, Children's Health is taking this initiative on now so it can effectively and efficiently respond to the unique needs of patients and their families."

John Halamka, CIO at Beth Israel Deaconess Medical Center and Dean for Technology at Harvard Medical School, has several initiatives underway. They include collaborations with Google, Amazon, IBM Watson Health, Nokia, and others in areas such as machine learning, Internet of Things, telecare, mobile enablement and geolocation.

Also, Halamka has planned numerous mobile app deployments that layer on top of existing EHRs to provide enhanced usability and workflow. On tap are cybersecurity enhancements, blockchain pilots, and a shift in thinking from provisioning services to procuring cloud services, shrinking local data center and disaster recovery assets.

Mark Lantzy, senior vice president and CIO of Indiana University Health, is at work on an EHR Optimization project called "Uplift." 

"It's exciting because it is focused on improving the physician and nurse experience with the EMR with early results demonstrating increased satisfaction and reduction in 'pajama time.' "We're taking it on now because there is no better time than the present to improve the physician experience with the EMR," he said. 

Lantzy and his team are also working on improving quality measures and care coordination and reducing the cost of care. The goal is to improve population health management capabilities, he said. In preparation for Windows 10, the team is also working on a desktop replacement project. It presents opportunities to improve productivity and reduce total cost of ownership, he said. 

Cleveland Clinic CIO Edward Marx said the organization is adopting several new best practices inside of IT. One is related to IT Service Management as the team fully matures ITIL. Also, the team is adopting Business Technology Management as it seeks to drive up the value of IT while lowering costs. 

"Finally, we are adopting "agile" not as an effective tool for projects or development," Marx said, "but rather redefining the way we work. We are reorganizing ourselves much like many Silicon Valley companies so we can improve quality and become increasingly efficient."

Albany Medical Center in Albany, New York, has affiliates in Saratoga Hospital and Columbia Memorial. As the medical center continues to grow, it faces challenges of integrating computing, technology, biomedical systems and analytics capabilities for scale and economies, said George T. Hickman, executive vice president and CIO.

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

LAS VEGAS – Robert Wachter, MD, is not nearly as grumpy as he used to be about EHRs. At least that's what he told the standing-room-only crowd at the CHIME CIO Forum at HIMSS18 on Monday.

Wachter is chair of the Department of Medicine at the University of California, San Francisco. He is also the author of "The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age.”

"If you had heard this talk two or three years ago, he told his audience, it would have been pretty grumpy,” he said. “I find today things are getting a lot better.”

He pointed out that 10 years ago fewer than one in 10 American hospitals had electronic health records. But today, fewer than one in 10 do not. 

"It's not hyperbolic to say that in the last decade we've gone from the most information-intensive industry known to man whose information backbone was a piece of paper, a post-it note and a fax machine to one whose information backbone is the electronic health record and all the digital tools that surround it.”

Wachter also gave credit to the government for helping with the transition.

“For $30 billion, the federal government succeeded in digitizing a $3.5 trillion industry," he said, referring to the HITECH Act, which helped fund the digitization of health records.

But the thing that heartens Wachter the most these days is that we're starting to see examples of this idea of reimagining the work. "The technology is very important," he said. "But to me, this is where the critical issues are, he said. To me, the key issue is how will this really works for real patients, real doctors, real organizations."

As for emerging trends, Wachter is watching the transition to value-based care closely.

"Our new mandate is value. … You and I are now under pressure that we were not under 10 years ago, to deliver care that is high-value, better, safer, less expensive, more accessible, more equitable."

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

LAS VEGAS - It was dire stat. Physician satisfaction was 1 percent at Lafayette General Health in Lafayette, Louisiana. 

But after a years-long project to improve physician satisfaction, the health system managed to drive that up to 58 percent for its 68 employed and 1,700 non-employed physicians.

According to Amanda Logue, MD, chief medical informatics officer, a lot of the troubles stemmed from technology.

“IT was the first, at the bottom,” Logue said at the Business of Healthcare Symposium at HIMSS18. “We could only go up from there.”

According to Edwina S Mallery, assistant vice president of information systems, “Our physicians were requesting additional technology. They wanted to see radiology on their iPads.”

EHR troubles also plagued the system.

The focus became integrating the patient record and portal into one single view and experience. It was extended into the medical community, including the independent doctors, to include the hospital, primary care physicians, specialists, lab results and more. 

“We have one record, one patient portal,” Mallery said. “We engaged physicians for a stronger alignment.”

Alignment, standardization and telehealth added the capacity for physicians to see one to two additional patients per day in their clinics.

In 2013, the system formed a clinical transformation committee. Members included the CEO, CMO and CFO. They found service lines to align and several have received the centers for excellence designation.

Service lines include advanced primary stroke, joint replacement knee, joint replacement hip, joint replacement shoulder, stroke rehab center, bariatric, breast imaging and maternity care distinction.

“For population health and utilization we came up with practical ways for disease management,” Logue said.

This has resulted in reducing avoidable ED visits and admissions, the latter by $2.9 million. Physicians can see the stats, and have a healthy discussion amongst themselves to find a solution, she said.  Many times the data can be drilled down to an individual provider. Peer pressure can be a motivator.

As with many new starts, Lafayette suffered setbacks. The system originally had a physician dedicated help desk staffed by internal analysts, that had a high level of recognition and customer support.

They outsourced the help desk two years ago, with disastrous results.

“They were answering phones quickly but the level of relationship was non-existent,” Logue said.

In 2017, Lafayette brought back the internal help desk staffed by analysts, who have said they’re learning a lot by taking the calls for physicians.

Since 2013, physician satisfaction is measured each June.

There’s staff “roundings,” a 20-minute one-on-one interviews with the top 200 practicing physicians, asking key questions about what’s going on in the organization. 

“The major thing we did was to act on those results,” Logue said. “We shared the results with the clinical transformation committee.”

Physicians serve on the board of directors and also on the network executive committee. Most are not employed by the system.

The physician satisfaction survey results have plateaued at about 82, 83 percent, but they’re still working towards a goal of 90 percent.

It’s an ongoing mission, according to Logue.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

LAS VEGAS -- Eric Schmidt delivered a hearty dose of optimism Monday evening in the HIMSS18 opening keynote.

“A revolution has been happening in my industry. Scale changes the rules, scale changes everything,” said Schmidt, who is the former Executive Chairman of Alphabet and today serves as a Technical Advisor to Google’s parent company. “The combination of cloud, deep neural networks, the explosion of data will give you a model."

HIMSS CEO Hal Wolf said that healthcare is at a critical moment. Organizations in countries around the world are facing the same challenges of too little funding against the oncoming Silver Tsunami bringing new aspects of disease burden and savvy consumers who turn to Dr. Google when hospitals cannot deliver what they need.

“We’ve come to the point where we’re building upon investments in IT to use the massive amount of data that comes out every day and transforming that data into information and knowledge,” Wolf said. 

Schmidt pointed as example to a theoretical technology product he called Dr. Liz — named in honor of the first woman to earn a medical degree, Elizabeth Blackwell — a scenario wherein a voice assistant in patient rooms interacts with consumers, makes evidence-based recommendations to doctors and handles all the administrative burden of working in an EHR. 

“Everything I just described is buildable today or in the next few years,” Schmidt added. “All it takes is for all of us to figure out how.” 

That’s not to say it will be here tomorrow, but Schmidt laid down a clear path toward just such an innovation akin to email, the Internet or smartphones that will be the proverbial killer app that causes all sorts of interactions and connections.

Here’s what Schmidt said that will take: A clinical data warehouse packed with diverse data sets that are curated and normalized such that sophisticated analytics can be run against the data and accessed with a rich API. Hospitals then need a second tier of data to supplement EHRs.

“EHRs are an incredibly important breakthrough in getting data in place, revenue opportunities, and they manage the workflow of the organization,” Schmidt said. “The sum of what they do is crucial. But FHIR will not fully get the information out and that’s why you’ll need the mid-tier data store.”

The only way to achieve that is by adopting the principles of cloud computing and doing so quickly because the cloud is safer, more HIPAA compliant and easier to use, Schmidt said, adding that of course he wants hospitals to use Google’s cloud but urged that picking a competitors cloud services is better for everyone than not using any at all.

“We need a common data store, normalized data, longitudinal trend analytics and machine learning, the ability to predict next steps, voice translation, transcription and language recognition,” Schmidt said.

Reinforcement learning requires those powerful networks. Schmidt described the concept of consisting of a simulator, training data, real-time experience to that looks at forward outcomes.

“We believe we can build reinforcement solutions to significantly improve pathways of care,” Schmidt said.

HIMSS CEO Wolf noted that these challenges are not just about information that comes from within healthcare institutions, but also data that comes from the outside.

“How we harness the information is our next critical step,” Wolf said. “This gets to the heart and reflection of where we are in healthcare today and how we think about AI, machine learning, clinical decision support, clinical pharmacy, using data from mobile devices. It is the power of information and technology that gives us the opportunity to deliver services back to the consumer and the consumer back to us.”

Schmidt last spoke at HIMSS in 2008 and in 2018 he promised if he’s invited back in 2028 he will bring the equivalent of Dr. Liz.

“We’re closer than many think we are,” Schmidt said. “This phenomena has been happening over and over again during the last 40 years of my career — so I know it’s the path forward.”

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

Health IT giant Cerner announced Monday at HIMSS18 a new collaboration with Salesforce, a customer relationship management technology vendor. Cerner is extending its population health and clinical and administration portfolio with an integrated system that combines Salesforce Health Cloud and Marketing Cloud with Cerner’s HealtheIntent, its Big Data platform.

Combined with Cerner’s data/analytic/application platform, electronic health record and other systems, the addition of Health Cloud and Marketing Cloud is designed to support enhanced consumer and provider engagement.

“We are entering the next phase of healthcare delivery transformation; this collaboration with Salesforce will bring game-changing solutions to consumers, allowing them to participate in their physician’s decision-making and engage in their own health and care,” said Zane Burke, president, Cerner. “We have digitized EHRs and are now aggregating and enriching this data for clinical and engagement insights through applied intelligence.”

LAS VEGAS – Brent Shafer, who took the reins at EHR giant Cerner last January after a 12-year stint as CEO of Phillips, is not only aware but also respectful, of the fact that he is filling big shoes at Cerner.

Shafer has taken the CEO position left vacant after the death of Neal Patterson, who was also co-founder and CEO of the company.

"What I'm really excited about in coming to Cerner -- kind of coming from a different background -- I've got this 30 years of experience in sort of all ends of healthcare.” He's worked in healthcare from the consumer end of and across all the segments, including some elements of healthcare IT.

"I've seen it from all points of view, and I've known Cerner through all those years and seen Cerner's growth, its maturity and expansion," he said.

Since, coming on board at Cerner, Shafer has spent time getting to know leadership within the company. 

"It takes time to make all those personal relationships, he said, "but it's absolutely essential."

"I think the senior leadership, to a person, are very devoted to the mission. There's a very strong commitment to what Cerner's about, what we’re here to do -- to improve healthcare," he said. "You can really feel that goes very deep in the culture."

He points out there are 16,000 people working at Cerner in Kansas City alone. Shafer will be traveling soon to meet Cerner's European affiliates, he said.

What does he want to tackle first?

He's still in the listening mode, he said. He's spending a lot of time with clients, hearing what they have to say, what their needs are, what their experiences are with Cerner. He's also met with potential clients to see what they'd like the company to do -- what would make them more appealing and more attractive in the marketplace.

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

Asked to talk about himself outside of work, what he likes to do, Shafer goes immediately to his role as father: Twin sons, who are now 31 years old and a daughter, who's 26.

He grew up skiing and engaging in outdoor activities in Utah and other Western states. Today, landing in Kansas City, home to Cerner, Shafer says it's a bit like coming home. The area feels familiar because of that Midwest feel, he said.

"It's very exciting to come now, to be part of Cerner's future," he said.

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

“Every great story starts with a tipping point. You have to have something that made you make a Herculean change.”

For Detroit’s Davies Award-winning Henry Ford Health System, that came around 2009 as they faced a significant challenge thanks to a splintered legacy record system that involved, among other things, 25 different systems where patients could be registered. That would never stand up to ICD-10 or meaningful use and the pressure was building.

“We no longer could use our environment and we knew we had a deadline. That was our challenge,” said Henry Ford’s Vice President of Clinical Transformation Geoff Patterson.

[Also: How Henry Ford Physician Network made the numbers work in the Next Generation ACO]

They committed to implementing the Epic EHR system and launched Project HELIOS, Henry Ford’s electronic integrated information system.

“The goal was to strengthen our commitment to improving people’s lives. It was all about the patient. We were looking for standardized process and workflows and using technology to get us there,” Patterson said.

With buy-in at all levels and oversight from system leaders, Henry Ford made the commitment early that they would standardized for system-wide consistency, training would not be optional and they planned for the post-live and long-term sustainment. Most importantly, the patient would be at the center of all decision making when it came to standardization or any of the coming changes.

“So if it impacted them negatively, it was actually challenged as decision,” Patterson said.

Henry Ford deployed Epic across the system and created an enterprise data warehouse and a central business office that housed a unified revenue cycle department. All facilities had to standardize and come up with uniform processes, right down to  the pharmacy committee standardizing the formulary.

The gains were incredible.

First, HELIOS allowed them to insource about 650 IT consultants with a retention rate of about 98 percent. Transcription was a big area in need of change. Doctors in the system used transcription services often and it was costly, with a burn rate of several million dollars a year for transcription and dictation vendors. Once they started using Epic to document instead, they saw about $135,000 a month in savings, along with another $100,000 in monthly savings thanks to standardization of forms and electronic distribution which greatly reduced paper, postage and processing. 

Pharmacy Formulary Standardization saved them another $83,000 a month too. They also now have a master patient index. So when an event happens at Henry Ford, it all gets documented the same way. They standardized contracts, terms and conditions and were able to eliminate maintenance fees and other costs that came with their previous overly varied environment and migrated all their legacy applications so that the data is now stored in the current system.

Patterson said they would not have achieved meaningful use without Epic, grabbing almost all MU opportunity to the tune of about $68 million. They have also achieved HIMSS Stage 6 with their inpatient and ambulatory operations and have set a goal of HIMSS stage 7 within the next 18 months.

“We’ve got stage 7 envy, but we’ll get there eventually,” he said.

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

Last year about this time, Epic Systems founder and CEO Judy Faulkner announced at HIMSS17 she would create two smaller EHRs for those healthcare enterprises that did not need the full-blown version of Epic's EHR. 

She did just that. Those offerings are available today and being demonstrated at the Epic booth. She wrote the code herself. She enjoys coding. It's been in her wheelhouse for years.

Now Faulkner is onto other work near and dear to her -- augmenting the CHR, or comprehensive healthcare record -- to take into social determinants of healthcare.

"Most health systems know they have to go beyond their walls," she told Healthcare IT News in an interview at Epic’s artsy and quirky booth on the show floor. It's the place where art and technology meet. 

It's not the first time Faulkner has championed the moniker CHR, “comprehensive health record,” in lieu of EHR.

As she sees it, everything is electronic. It's another thing to be comprehensive. Being comprehensive has the high possibility of making a difference in a patient's life. 

In doing more work overseas over the past year, she found the value the CHR concept could have on providing better care is clear. Finland is big on social determinants. Faulkner sees how critical social information -- such a patient who is lonely, for example -- can be to providing the right care. 

Social determinants will play a greater role in caregiving, she expects.

Among the resources she sees at play in this area are food pantries, school programs, group homes, Mental health and substance abuse programs, child and family programs, disability programs social assistance and transportation.

Faulkner is also highlighting "One Virtual System Worldwide," an initiative Epic launched in January 2018, aimed at making it easier for Epic shops to exchange data and collaborate more around it. The idea is to make it easy to view data in a single merged view. It could include images, family history, notes and other elements, including social determinants.

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

LAS VEGAS – While eClinicalWorks is demonstrating its latest cloud-based EHR and new offerings for inpatient settings at HIMSS18, CEO Girish Navani gave a glimpse of the forthcoming iteration — and the goal is to resemble a Bloomberg Terminal.

The hosted service would make a bold step forward for the EHR vendor that last year settled a $155 million case with the U.S. Department of Justice in a False Claims Act suit.  

Much in the way the Bloomberg device delivers information to help bond traders make decisions in near real-time, the next version of eClinicalWorks will provide doctors with four key technologies each on its own screen.

Navani described the setup as such: A physician walks into her office with a big monitor that has a population health panel containing information about the patients the doctor will see that day, a telemedicine tool for virtually connecting with patients, a voice-based virtual assistant for interacting with the software and a machine learning-based panel making evidence-based clinical suggestions.

“We spent the last decade putting data in EHRs,” Navani said. “The next decade is about intelligence and creating inferences that improve care outcomes.”

Navani pointed for example to machine learning’s potential use cases in the common alerts about lab results that can flood a doctor’s inbox. Machine learning could not just separate the abnormal results that require immediate action from the normal one that do not but, what’s more, it could identify an atrial fibrillation patient with a high potassium level who needs to go to an ambulatory facility immediately because a serious problem could manifest in 24 to 48 hours.

“There is enough information now for machine learning to work,” Navani said. “We can have the computer do things for the clinician to make them aware of actions they can take.”

eClinicalWorks is currently developing the software to recognize hardware monitors, such as Microsoft Surface, that work with Google Chrome, Navani said.

Navani said eClinicalWorks is planning to debut the forthcoming version, roll it out in late 2018 into early 2019 and show it at next year’s HIMSS conference.

eClinicalWorks is in Booth 145. 

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

LAS VEGAS – In an evening session at HIMSS18 on Tuesday, National Coordinator for Health IT Donald Rucker, MD, sat down for a candid talk about an array of issues related to federal healthcare policy, interoperability, user experience, patient engagement and much more. Here's a sampling of what he had to say.

On bipartisan agreement about the value of health IT:
There are two areas of focus we at ONC have these days, as we look at the status of electronic health records in the United States: One is usability and provider burden, and the other is interoperability. There's a great luxury, which I think is a rarity in Washington, that both houses of Congress, both parties, the prior president, the current president, are all united on these goals.

On the necessity of better interoperability:
A lot of our work is driven by some excellent work from Congress in the 21st Century Cures Act. It really sets a number of national priorities on interoperability. As we talk about concepts like information blocking, the Trusted Exchange Framework and open application programming interfaces, those are coming to us straight out of the Cures Act.

If I know more as a provider about a patient, I'm going to be able to give better care. My clinical career has been in emergency medicine, and we're often in the ED guessing about what might have happened. Patients often forget things, and some are just unknowable. 

On handling the increase in data that comes with more robust data exchange:
We have discussions about clinical document architecture, etc. But it is our belief that computer science will provide a variety of tools to help both providers and patients with a summarization of data. I don't think it's just going to be just a raw deluge that we can't process.

On the value of smartphones and apps:
If you look at data liquidity, you look at the rest of the world. And in that app economy, many use services that are absolute mash-ups, roll-ups of a variety of different app technologies. Uber and Lyft come to mind. We're living in an environment where the computer in your pocket or purse is creating lots of different business models. We absolutely anticipate that to happen in healthcare and some of it already is.

Either you're looking at things that don't have medical data, or you're looking at things that just have medical data. You're not looking at things that synthesize knowledge about our environment and our lives and our behaviors with medical data. That is really the opportunity here.

On EHR usability:
The whole usability burden is a complex thing. As we look at usability, it all looks like it's the all the computer. But it's a combination of things that have their location in a computer. ONC is doing reporting under Cures that is going to serve as guidance to CMS on reducing some of those burdens. John Fleming, our Deputy Assistant Secretary for Health Technology Reform, who has installed three separate EHRs over the years, is leading that work. We're trying to separate some of these things out: What's the user interface component of this, what's the documentation component, what's the reporting? We're dissecting it out and trying to address some of the issues.

On his hopes for TEFCA:
The Trusted Exchange Framework and Common Agreement is the concept that the various networks talk together: regional health information exchanges, Carequality, CommonWell, some other ones. Getting those to talk and leverage the work they've already done. And getting them to expand their use cases, which today are almost always narrowly defined as provider to provider. We should leverage them – direct to patient, to payers who buy all of our healthcare, so we can actually see what we're getting in this country when we purchase healthcare.

On information blocking:
Some of this data has been locked up. Congress has put explicit language in 21s Century Cures about information blocking, and we will be working with CMS to make sure some of the more parochial interests align for the common good.

On what makes interoperability so hard for healthcare:
What makes it hard is that you have to solve for multiple things at once. We have to solve simultaneously for just the physical wiring, the interoperability stack. We have to solve for the simple syntactic standards of data transmission. We have to come to some consensus for semantic interoperability: what was the meaning of what was transmitted. And then finally, we have to deal with the business case. And the business cases are hard to deal with because some of these cases are virtual things in the future, involving competitors, and business models that don't exist at the present. And if that weren't enough, we have to do it with privacy and security. That's what makes it hard.

On his long-term vision for interoperability:
I think there are two powerfully exciting things about the end state, or at least as far as we can imagine. I think one is that patients control the data on their phone and the chart goes with the patient rather than the provider. I know that's a radical idea in an environment where the provider owns the chart and the patient moves around, but I think we're at a point where that can be reversed.

And what that means is that there will be a whole different level of patient engagement. We've been a very passive country about healthcare. And as we get more information and re-engage in shopping – there's one thing Americans are good at, it's shopping. But we haven't really done very well shopping with healthcare.

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

LAS VEGAS – America’s Health Insurance Plans CEO Marilyn Tavenner on Tuesday called on all insurers to give patients their claims data electronically.

“I totally agree patients should have access,” Tavenner said.

Her statement came in response to an earlier announcement by Centers for Medicare and Medicaid Services Administrator Seema Verma that the agency has plans to improve interoperability.

“I’m 100 percent behind what she had to say,” Tavenner said during a lunch at HIMSS18.

But while there remains to be seen exactly how that will play out, Tavenner said health plans such as Blue Shield of California are already working on improving that kind of transparency.

Blue Shield of California on Tuesday announced that beginning this year it will require network providers, including participating accountable care organizations, to agree to participate in Manifest MedEx, a nonprofit health information network that is creating comprehensive, real-time digital health records for all Californians.

Blue Shield is asking its ACO providers to sign a participation agreement with Manifest MedEx by Aug. 31, and for other network providers to do so as a part of their next contract renewal. 

The employer market is stable, Tavenner said, with about 160 to 180 million consumers. But that segment is also changing in approaches.

For example, employers are moving beyond gym membership for wellness initiatives to biometric screenings and having on-site nutritionists, she said. There is also a great deal being done with stress management.

The agenda for the next two years includes promoting value-based insurance design, expanding telehealth, health and wellness benefits in employer-provided coverage, the expanded use of health savings accounts, increased drug price transparency and greater cost transparency.

Prior authorization is another area needing work, she said. The prior authorization process should be simplified in the move to value-based care, she said. If an insurer gives X number of dollars for a surgical procedure, then it doesn’t matter if one or four MRIs are ordered. 

“They are doing what is appropriate for the person,” she said. “Then you don’t need historic prior authorization.”

Anthem is currently working with the American Medical Association on a project involving prior authorization she said, without elaborating.

Another area of focus is the opioid epidemic.

“From an economic perspective, the sound bite for me is why does the U.S. have 90 percent of the opioid use?” she said.

Centers for Disease Control and Prevention guidelines on opioid prescribing that have been out for 18 months should be followed, she said. 

Tavenner was a key administrator for the Obama Administration in running CMS as insurers grappled with the Affordable Care Act market.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

The HIMSS Immunization Integration Program on Wednesday announced that five health IT products have met its criteria.

Those are Cerner’s FirstNet and PowerChart, Glenwood Systems’ GlaceEMR, HealthCareXchange’s TheVaccinator, Qvera’s Interface Engine and the Physicians – Practitioners Office Assistant from Electronics Services Technologies.

The initiative, supported by the Centers for Disease Control and Prevention and approved for health IT certification by the Office of the National Coordinator for Health IT, is designed to improve the quality and timeliness of immunization-related data public health departments exchange with private providers.

“The program is focused on the immunization encounter and making sure EHRs have immunization capabilities that will lead to better clinical decision making, reporting and information sharing, forecast delivery with registries, to get more complete records into these systems,” said Warren Williams, branch chief, Immunization Information Systems Support Branch, National Center for Immunization and Respiratory Diseases at the CDC. “It's important that the quality of immunization-related data public health gets from providers is as accurate as it can possibly be.”

Public health agencies, in turn, can provide better information back to those providers. Having more accurate data during clinical encounters enables doctors and nurses to deliver better care by having a patient history and a forecast to know what shots a person needs, for example.

And it helps hospitals and EHR vendors meet meaningful use requirements, Williams said.

“We were pretty excited that ONC recognized the program as an alternate testing method,” Williams said.  “Vendors participating in this can also get credit for achieving that criteria against ONC certification – I think that’s a benefit for us as well as ONC.” 

HIMSS announced the IIP in July of 2017 with collaborators Drummond Group and Chickasaw Health Consulting.

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

LAS VEGAS – "I could ask the audience what population health is, and I would probably get 100 different answers," said Terri H. Steinberg, chief health information officer and VP of population health informatics at Delaware's Christiana Care Health System at HIMSS18 on Tuesday. "And every single vendor on the show floor thinks they know how to define population health."

The reality is that "EMR vendors and other technology vendors all approach population from their own view," she said. "If you're Cerner or Epic, you're good at hospital EMRs and ambulatory EMRs, and you're going to expand from that. If you're Medecision or another population health vendor, you're going to expand into the walls of the hospitals and doctor's office from your own perspective. But the bottom line is it doesn't really matter – because you have to manage the population."

Steinberg speaks from experience. In just a few years, she helped lead Christiana Care from a fee-for-service holdout to a successful and sustainable model of value-based care management with nearly 200,000 members.

"In 2015, Christiana Care was one of the last bastions of fee-for-service medicine," she said. "We had a single large payer and we both sort of made the rules together."

But a Center for Medicare and Medicaid Innovation grant to implement a comprehensive care management program and an analytics-based IT platform helped changed its ways of thinking.

Along the way, "we realized that we were very happy to deliver services for which you can't drop a bill," said Steinberg. "Social work services and pharmacy services and other things that really move the needle but you can't deliver in a fee for service world.

So Christiana Care execs "approached the payer and said, 'We want risk. We want as much risk as you can throw at us.' And so our risk-based model was born."

Three years ago, the health system launched Carelink CareNow, a wholly-owned subsidiary that essentially operates as a care management company. It has contracts including ACO, direct to employer and payer partnerships, and comprise some 180,000 patients in the region.

Over recent years, the system has learned some valuable lessons about what it takes to succeed with population health, said Steinberg.

For one, "we manage all of our members all of the time," she said. "We rely on the technology to really bring to the attention of care managers things that are actionable. So the notion of a single panel or patients or a specific ratio is really almost an anachronism in the Carelink world."

And contrary to some folks' unfounded fears that accountable care means rationed care, "we've discovered that when you make your care levels actionable based on data, some people get a lot more than they ever thought they needed," said Steinberg. "Because the care comes to them. There's outreach to the member. Some people get more, some people get less. It's based on algorithms."

A critical component of evidence-based care delivery, she added, is to abide by a simple rule: "Don't do things that you can't measure. Because they're probably not important. And if they're important, you probably should be measuring them."

To be successful with pop health, you have to segment the population – whether that population is diabetics or NICU babies, said Steinberg. It's a complex process, and heavily dependent on clean data, sound processes and robust analytics.

But once that's done, the recipe for customized interventions for "right-sized care" essentially has just three ingredients, she said: Technology (for data integration and real-time triggers); care coordination ("the glue between doctor's visits – probably more important than the visits themselves"); and analytics ("to prospectively assess your risk and drive care to the right direction, you need to monitor how you're doing and feed that back to your organization and the providers").

All easier said than done, of course. But when tackled in earnest, such process changes can pay big dividends. Christiana Care has managed to gain improved utilization measures, reduced readmissions, substantial cost savings and (not insignificantly) increased provider and patient satisfaction.

Among the notable stats: It's seen a 30.4 percent reduction in the 90-day readmission rates for patients with total hip or total knee replacement; a 13.9 percent reduction in the 90-day readmission rates for congestive heart failure patients and an 11.8 percent increase in CHF patients being discharged to home with self-care or home health care.

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

LAS VEGAS – Medsphere Systems is moving its CareVue electronic health record to Amazon Web Services' cloud infrastructure, the company announced at HIMSS18 on Wednesday.

The open-source, subscription-based CareVue EHR, whose OpenVista technology derives from the VA's pioneering VistA system, now offers small, rural and community hospitals a platform-as-a-service option to manage their data, bolstered with extra cybersecurity measures on top of AWS' own robust security protections.

"Our goal has been to balance out the tension between security and system access, and we’re confident that CareVue Cloud creates peace of mind without putting unnecessary burdens on clinicians," said Medsphere CEO Irv Lichtenwald in a statement.

Many hospitals and health systems have long harbored deep skepticism about the security vulnerabilities of cloud-based IT systems, but in recent years technology decision-makers have been increasingly convinced that the cloud offers strong data protections while also enabling speed, agility and cost-efficiencies.

At HIMSS18 on Tuesday, Mark Johnston, director of global business development for healthcare, life sciences and agriculture technology at AWS, agreed that industry-wide there's been a tipping point of sorts that has changed a lot of minds about the cloud.

That partly has to do with Amazon’s' strong cybersecurity track record, he said. 

"We have a really significant portfolio of security services now that people can basically take as Lego bricks and just put together," he said. "It helps organizations build more robust, scalable, secure, compliant solutions, with a fraction of the effort they would if they were to host it in their own data centers."

For its part, Medsphere aims to reassure its hospital customers by adding to AWS' system redundancy safe sharing protocols – protections many hospitals are would be hard-pressed to build on their own – with even more security features for CareVue Cloud.

Medsphere officials say these include a security-focused design philosophy (separate systems are isolated from each other, while live and backup systems are geographically distinct); access control (communication via IPsec VPNs and multi-factor authentication); data encryption (both in transit and at rest) and disaster recovery and business continuity capabilities (enabled by constant data replication and hourly system snapshots).

Earlier this week, Johnston presented a session at the HIMSS Cloud Computing Forum and aimed to debunk various outmoded myths about the cloud. He encourages open minds about what tech-as-a-service can do for health organizations of all shapes and sizes.

"It's here, folks, it's time to get going," he said. "Let's leave all our old belief structures behind and reinvent our organizations so we can transform healthcare."

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

LAS VEGAS – PointClickCare Technologies, which develops software-as-a-service for long-term and post-acute care providers, announced a new program at HIMSS18 on Thursday designed to give software developers a streamlined, integrated process to create LTPAC-focused apps on its platform.

Officials say it's meant to be a quick, cost-effective way to foster new third-party integrated solutions with help from a robust set of application program interfaces.

The program offers developers with access to documentation, data and other insights, leveraging standards-based APIs to enable creation for the PointClickCare electronic health record platform, which is widely used in the LTPAC market, boasting 60 percent market share in the skilled nursing space, according to the company.

“Through our new Developer Program, not only are we enabling integration between health systems and their post-acute providers, but we’re supporting a burgeoning developer community and improving patient care through innovative new solutions,” said David Belbeck, PointClickCare's executive vice president of corporate development, in a statement.

Post-acute care was a hot topic at HIMSS18. The annual LTPAC Forum, for instance, again convened long-term and post-acute care providers and technology developments to continue innovating ways to bridge the gap between different types of providers. Education sessions focused on longitudinal health records, interoperability and patient engagement across various care settings.

“Ultimately, the goal is to be able to empower our customers and health systems to work smarter and better together, and with the right tools we can help them achieve better care coordination across the continuum,” added Bill Phelan, senior vice president of Product Management, PointClickCare.

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

LAS VEGAS – Members of the HIMSS Electronic Health Record Association met at HIMSS18 on Thursday, and offered a briefing on some of the big issues its vendor members are focusing on this year so far.

Speaking on behalf of EHRA, several experts from leading EHR developers weighed in on their current efforts to gain clarity in the language of the draft Trusted Exchange Framework and Common Agreement, improve patient safety features, alleviate clinician burden and more.

The first topic of discussion for the EHR developer trade organization was TEFCA, which was published by the Office of the National Coordinator for Health IT in January, and which EHRA has said still needs "a lot more work."

Hans Buitendijk, director of interoperability strategy at Cerner and EHRA's standards and interoperability chair, said the draft framework called for "too many things at the same time" from software developers.

"We hope that ONC will have one or two more rounds, where we can look at the direction of what's going to happen," he said, noting that TEFCA puts a "substantial amount of capabilities on the table to be done in a very short period of time."

Specifically, he pointed to certain requirements that he hoped could be better harmonized, for instance, the U.S. Core Data for Interoperability and information blocking related rules, "we hope to see some relationship between those, that one could take advantage of the other," said Buitendijk.

For another, he mentioned questions around "how does everybody contribute to these networks and what can we do in this space."

There's "not much debate that patients need access to their data, easily," he said, "but as we get into other parties that participate in those networks, what kind of reciprocity is there for data exchange, or benefits that organizations get from that. We have to make sure that it creates a sustainable business model for everyone.

EHRA Chair Sasha TerMaat, director at Epic, noted that right now there are no current entities that meet TEFCA's definition of a Qualified Health Information Network.

"A lot of organizations are ruled out of being Qualified HINs by how they define it," she said. "And the requirements to be one, there's a lot of expensive aspects. So any network that would think about doing it is going to have to make big investments in infrastructure, in agreements with their participants, and so forth.

EHRA, she said, wonders whether it "has to be as expensive and as far out in the future as that model makes it seem, or are there changes we could suggest that would help it move faster. There's too much recreating the wheel. We've suggested a lot of changes to ONC in our feedback and would like to see them come out with a second round for comment. My goal would be to unite the networks that already exist today as the fastest way to interoperability."

In general, Buitendijk said the draft framework is "taking quite a big jump," and suggested ONC "take a more modular approach, a more step-wise approach – build on what we have and improve upon it, rather than take a substantial leap in a very short period of time."

Leveraging EHRs to fight opioid crisis

Allscripts VP of Policy and Government Affairs Leigh Burchell pointed out that EHRA had recently launched a task force to explore ways IT could further be brought to bear to help combat the opioid abuse in the U.S.

"We've gotten fantastic participation from pharmacists, health experts, doctors, technical experts, looking at it within the frame of health IT," she said.

EHRA is focused on several areas, said Burchell. First is policy, offering input for numerous bills in Congress and working with CMS and ONC to offer its members' technical expertise.

And also on physician burden, through a second workgroup called Clinician Impact, which is focused on what the response to the crisis is doing to physicians' workflow – given the demands of prescription drug monitoring programs and e-prescribing of controlled substances – and looking closer at clinical decision support to help present information that can help them make smart choices about pain management.

"We want to be sure that our systems respond to a way that doesn't create frustration," she said.

One of the biggest challenges the group has found is "significant inconsistency from state to state in how they're approaching it, said Burchell. There's been PDMP adoption in most states, for example, but they're "all doing it differently: a different technology framework, a different data set required to be exchanged, EPCS and PDMP that aren't even talking to each other."

A third workgroup, then, focuses on standards and technology, which homes in on where those disparate approaches are challenging EHRA members' clients and aims to help bring guidance on consistency and efficiency to policy-makers.

"We have 50 different flavors, we have 50 different types of code, and it's more costly. It doesn't make sense to anybody."

Burchell noted that a lot of the conversation these days is focused on responses to people who are already addicted: "what to do for treatment, how to stem mortality – all very valid."

But she said existing pre-analytics capabilities could help providers "look at the population health level to see patterns in the community, and look at individual patients. Three scripts in X amount of time is indicative of a danger to go forward. It's not already too late, it allows us to get in the path of this."

The urgency of the opioid epidemic represents a big opportunity, said Burchell. "This is clearly a very compelling use case. People are really, really passionate about this. It's sad that we got to this point, where there's a crisis, but I do think it sparks people in a way that they hadn't been previously motivated personally.

Easing clinician burden, improving patient safety

EHRA members also offered updates on the efforts to improve the user experience of their products and to bolster their ability to prevent medical errors.

On the topic of usability, EHRA Clinician Experience Chair Emily Richmond, senior director at Practice Fusion, said the trade group has been focused on a couple areas.

First, the Electronic Health Record Design Patterns for Patient Safety whitepaper, a collaborative efforts that tapped clinicians and experts in user-centered design and human factors to develop recommendations and guidelines for designing the parts of the EHR that most impact patient safety.

Second, EHRA's Persona Library offered insights into the the various EHR end-users in various health settings – their widely different goals, problems and backgrounds – to help member vendors design for them more empathetically.

"It is difficult to generalize how users interact with their software, because there are so many products that are represented, that are intentionally different – different settings, different specialties, different types of clinician users," she said.

"If you don't understand who your users are, if you hear, 'I have a complaint about X,' well, who is complaining about X? Maybe that's not an EHR problem, maybe it's a regulation problem where they feel compelled to overdocument and we're just the vehicle. It's important to understand who it is, and why the complaint is there."

Shari Medina, MD, regulatory affairs specialist at Harris Healthcare and EHRA's patient safety chair, meanwhile, said her workgroup has been most focused on a couple key provisions of the 21st Century Cures Act: the FDA guidance on clinical decision support, and the provisions around having health IT developers be covered by PSO Protections.

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

Validic, a health data connectivity systems vendor, launched at HIMSS18 Validic Impact, a remote monitoring platform that enables remote care capabilities for existing clinical systems. For providers, Impact can augment the functionality of clinical systems, such as electronic health records and care management systems, by directly integrating into the workflow.

“Rather than creating an entire, disparate system to manage remote care, Impact works to fill the existing gaps in remote monitoring programs,” Validic CEO Drew Schiller said. “We are enabling teams to build customized programs that meet the needs of the health system and the treatment goals of their patients.”

Built on Validic’s core data connectivity system, Impact provides a device-agnostic approach to remote care, the company explained, offering the ability to leverage hundreds of in-home medical and wearable devices to support chronic and post-acute care programs. Impact is designed to help enable clinician management of various conditions, from diabetes and hypertension to COPD and others.

Technology can automate many of the manual tasks required in remote care today, making it possible for providers to improve access, experience and outcomes with data-driven remote monitoring strategy, the company said. Impact is designed to help ensure clinicians are more efficient in patient outreach, creating sustainable feedback loops, and managing larger cohorts of patients, added Validic, which is located at Booth 12014 at HIMSS18.

Meanwhile, Veta Health unveiled at HIMSS18 its new health data system aimed at creating better healthcare experiences for patients and providers. The new system works with existing electronic health record systems to help turn data into insights, the company said, moving toward enabling data-driven interventions and improving clinician workflow while providing insights into a facility’s or health system’s overall population health.

As patient care evolves to value-based care models, technology can help reduce or eliminate time-consuming care coordination, bring together data from multiple sources, and provide more visibility into patient activity outside of facilities.

The new Veta Health system includes a clinician portal that features patient vital monitoring features through the use of wearables, the tracking of medication and compliance through user feedback, the prioritization of at-risk patients, and the management and coordination of care with automated reminders and visibility into long-term care plans and procedures.

For patients, the system also features self-management tools such as user assessments and surveys, to-do lists, provider-driven content, visibility into personal health trends, goals and progress, along with a full history of health records and medications.

Veta Health is located at Booth 8700-8736 at HIMSS18.

Elsewhere on the clinical systems front, Medici launched at HIMSS18 Colleague Chat, a new feature of the Medici for Doctors app that enables physicians to communicate with peers, filling a primary need to facilitate collaboration.

With this feature, physicians now can invite their peers to communicate securely on Medici to discuss shared patients, verify treatment options, provide or solicit second opinions, generate new referrals into a specialty practice, and more. The goal is to improve patient outcomes and satisfaction.

Primary care physicians, for example, often need access to specialists to verify patient care options and to attain better insights into the appropriate management plan for patients with challenging healthcare situations. In addition, less experienced health workers can access support from colleagues to validate the course of patient treatment and better serve the needs of their patients, the company said.

The Medici for Doctors app is free via the Apple App Store or Google Play. Medici is located at Booth 11121 at HIMSS18

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