Centra Health, a Virginia cancer care center, began using clinical collaboration technology at its multidisciplinary lung cancer conference, primarily as a format to document the stage of the patient's tumor and share information with the entire team.

The healthcare organization had a big problem when it came to bringing together the opinions of different providers and directing a patient's therapy because the providers are in different offices or different organizations and on different EHRs.

The clinical collaboration technology worked. But it also began a complete restructuring of Centra Health's entire patient navigation through the cancer center and led to the realization of a longstanding vision that staff just didn't know how to bring to fruition.

"I know it sounds grandiose, but this simple app has allowed us to revolutionize what we are doing," said John Salmon, MD, a pathologist at Centra Health, which uses the technology, which is developed by QliqSOFT.

Once staff saw the communication benefit for lung cancer patients, they asked themselves: Why not do this for all cancer patients?

"And that led us to our most critical philosophical shift: We now identify all new cancer patients at diagnosis with a CareChannel," Salmon said, speaking of a communication thread in the QliqSOFT technology. "It may seem a simple thing, but the implications are actually quite profound."

Clinical collaboration is key to the successful delivery of healthcare, and as such there are many vendors providing different styles of clinical communication and collaboration platforms. These vendors include IBM Watson, Igloo Software, NTT Data, Vocera Communications and Windstream Communications.

[Also: Care coordination software merges physical and mental healthcare]

Centra Health staff use CareChannels to create a conversation among providers from different organizations and regions. They all participate in the care of cancer patients and use the CareChannels mobile and desktop apps to securely share patient information and send messages around different cases.

Any diagnosis of cancer is sent to the cancer care coordinator, a position designed from the ground up for this purpose. They start a channel on that patient and attach all of the appropriate providers, including primary care.

"This has given us the ability to begin taking care of the patient – making appointments, assigning a navigator, coordinating needed testing – often before the patient knows they have cancer," Salmon explained. "It has forced us to completely redesign our system, but has also given us the ability to create effective pathways for all patients, regardless of their diagnosis."

Not only does this process streamline communication, it engages a wider group of providers, improving the patient's access to all of the assets in the care community, he added.

Centra Health purposefully did not integrate the clinical collaboration technology with any other systems, like EHRs. It felt such integration might muddy the waters.

"This is the part I have had the most trouble explaining to people, whether providers, administrators or IT staff in all of our various community organizations," Salmon said. "We actually chose to not connect QliqSOFT to any EHR. We don't integrate it to anything else. And that is actually its greatest strength."

The biggest problem with communication in healthcare is not related to what information can be automatically added or pulled out of a system; fundamentally, the problem is communication, not being able to talk to each other, Salmon said.

"Because we don't have CareChannels connected to any EHR, it is able to provide visibility beyond the boundaries of those systems," he explained. "I have doctors who are part of their own ACO seamlessly communicating about patient care with doctors of other financially competitive ACOs. This is what patients want, and this is what we need to be doing as providers."

Centra Health is starting to add caregivers from completely different health systems out of town – an academic medical center, for example – to better coordinate patients' needs, he added.

Recently on a Saturday, Salmon saw a specimen from a patient who had bronchoscopy on Friday. The biopsy showed non-small cell carcinoma, but he needed some stains to tell what type before he signed out the case, so there was still no official record in the EHR.

"However, I didn't want to delay letting the providers know what is going on," he said. "So I started a Care Channel on the patient and I included our care coordinator, the nurse navigator for lung cancer patients, and the pulmonologist. I let them know that the patient does have cancer, but I am holding the report until I have more information."

Salmon quickly got a QliqSOFT message from the oncologist who was asked by the pulmonologist to see the patient, and of course he wanted as much information as Salmon could provide. So Salmon added him to the Care Channel.

"Now we are all connected; the patient is being seen and the next phases of treatment such as staging studies are being arranged, and yet the official report isn't even completed," he explained. "I don't know how you can do much better than that."

Ultimately, Salmon said that the interesting thing about communication is that one doesn't notice much when it is working; it's when it is not working that people are aware of it. He said it is hard to measure the efficacy of a technology like this with simple metrics.

"It is difficult to track a metric like, 'How often the right decisions were made because all of the important information was readily available,'" he said. "Also, we usually don't attribute mistakes to a lack of communication. In some cases we don't even consider that it is a mistake, provided the patient's care is not affected, and someone is going to pay the bills."

In healthcare, staff needs to be cognizant of metrics and data so that organizations do things that result in real improvements. But in this case, Salmon thinks it is time to stop getting stuck in the weeds and listen to everyone who is complaining that people need to communicate better.

"I don't need a spreadsheet to tell me that this type of solution is working for us," he said. "Examples like the one I just shared about the lung cancer show me that it is making an immediate, profound difference in the way our system is working together. And the better we connect the network, the more powerful everything on that network becomes."

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

The usability frustrations that doctors encounter with electronic health records are well known at this point but what has been less understood is the impact the software can cause to patients. 

EHR usability issues, in fact, may be associated with some safety events in which patients were harmed, according to a new study published in the Journal of the American Medical Association.

The analysis discovered that patient safety reports mentioning a specific EHR contained language suggesting that the EHR may have contributed to patient harm, though from 2013 to 2016 these issues represented less than 1 percent of patient harm events.

Researchers analyzed 1.735 million free-text patient safety reports from 571 healthcare facilities in Pennsylvania and another East Coast healthcare system. Only reports that used one of the top five electronic health products or vendors, and that were classified as “reaching the patient with possible harm,” were included.

[Also: A look inside the patient safety work Phoenix Children's is doing with Allscripts]

The researchers found that of the reported safety events, 1,956 of them, or 0.11 percent specifically mentioned one of the included EHR vendors or products and were reported as possible patient harm. And 557 of them, or 0.03 percent, used words that strongly suggested EHR usability contributed to possible patient harm. 

Of those latter incidents, 468 reached the patient and could possibly have needed monitoring to preclude harm; 80 could possibly have caused temporary harm; seven could possibly have caused permanent harm; and two and might have needed intervention to prevent a fatality.

What the researchers found looks at first blush like a small percentage, but here’s the rub: The authors caution that, due to a conservative approach in the way the data was analyzed, the actual numbers are likely underestimated. Partly, that’s due to the data coming mostly from Pennsylvania and they expect that if the analysis were scaled to cover the entire nation, the numbers would be higher.

Another possible reason the number may not reflect the whole story is that the study only looked at reports specifically mentioning the name of a vendor or product; oftentimes, clinicians don’t mention the names of EHR vendors when writing up patient safety reports.

And then there’s the fact that patient safety events are typically underreported, in some cases by five- or tenfold, according to the authors.

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

In a recent opinion piece published by the Harvard Business Review, David Blumenthal, MD, who served as the National Coordinator for Health IT from 2009 to April 2011, writes that Apple's recent pacts with big-name healthcare systems might indeed be poised to disrupt the healthcare industry.

Blumenthal co-authored the piece with former U.S. Chief Technology Officer Aneesh Chopra, and both contend the pact has not gotten the attention it deserves.

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

Apple's healthcare move"could herald truly disruptive change in the U.S. healthcare system," Blumenthal and Chopra write. How? "It could liberate healthcare data for game-changing new uses, including empowering patients as never before."

The idea is to give patients easier access to their own data.

They note the inability to make electronic data more liquid persists, which hinders efforts to follow the patient throughout the health system and stymies more sophisticated analytics – goals they see as critical to better patient care and research.

[Also: Timeline: How Apple is piecing together its secret healthcare plan]

And they hail the collaboration among providers of health and information technology services. They see the Apple-hospital agreement as a new era in health and medicine. They applaud the partnership. As they see it, the results will not likely solve all healthcare problems. But they believe the new deal could disrupt the industry.

"These problems notwithstanding, the announcement of this collaboration between leading American providers of health and information technology services likely signals a new era in health and medicine," they write.

The collaborating hospitals are:

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

The Apple-hospital partnership "will not solve all our healthcare problems," Blumenthal and Chopra write. "But they could really shake things up. And that is what the U.S. health system needs."

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

President Donald Trump ousted Department of Veterans Affairs Secretary David Shulkin, MD, from his role on Wednesday after months of turmoil within the agency and reports the secretary had fallen from the president’s graces.

The president made the announcement on Twitter, saying that he will nominate his personal physician Rear Adm. Ronny L. Jackson to replace Shulkin. Robert Wilkie, Department of Defense undersecretary, will serve as acting secretary in the interim.

[UPDATE: Shulkin slams 'toxic' Washington, speaks out against VA privatization]

Shulkin was the remaining holdover from the Obama administration. His removal comes amid a broader staffing shakeup within the presidency, including the removal of National Security Adviser, Lt. Gen. H.R. McMaster and Secretary of State Rex Tillerson.

The firing doesn’t come as a shock. Reports have been swirling for more than a month that Trump had lost patience with Shulkin, stemming from a negative VA Office of Inspector General report that claimed Shulkin misused federal funds on a summer European work trip.

[Also: POLL: What's next for VA's EHR plan?]

The tension mounted when Shulkin made claims to the media that he’d been given authority to fire misbehaving VA employees.

Shulkin is liked on both sides of the party aisle, and his work to modernize the agency has been commended by Congress. In his short tenure, he’s helped to pass 11 Congressional bills, all designed to bring change to the scandal-ridden agency.

[Also: With David Shulkin under fire, what's next for the VA's EHR modernization?]

He also launched a 24-hour hotline for veterans’ complaints, created a platform for tracking wait times at VA medical centers, worked to ease the backlog of benefit applications and jump-started the ambitious Anywhere to Anywhere telehealth program.

At the moment, there’s no word on if, or when, the agency will sign its planned contract with Cerner to replace the agency’s legacy EHR.

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

In June 2017, the U.S. Department of Veterans Affairs announced Cerner would replace its legacy VistA system. But now that VA Secretary David Shulkin has been fired by President Donald Trump, we're wondering what you think should become of the VA's EHR plan?

Last night, President Trump announced on Twitter that he was ousting Department of Veterans Affairs David Shulkin, MD and advocating for his personal physician Rear Adm. Ronny Jackson as a replacement.

After more than a month of rumored agency infighting and Shulkin falling out of Trump’s graces, Shulkin has finally broken his silence and is using this platform to speak out about what he sees as those “putting their personal agendas in front of the well-being of our veterans.”

[Also: Trump dumps VA chief David Shulkin, will give his personal doctor oversight over agency]

“I have fought to stand up for this great department and all that it embodies,” Shulkin wrote in a New York Times OP-ED. “In recent months, though, the environment in Washington has turned so toxic, chaotic, disrespectful and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve.”

"It should not be this hard to serve your country," he wrote.

Shulkin specifically called out those within the agency pushing to privatize veterans’ healthcare -- a move he has continuously spoken out against to Congress. In fact, just two weeks ago Rep. Debbie Wasserman-Schultz, D-Florida asked Shulkin directly if he was being pushed to privatize care.

His response? “I’ve been clear that I think this would be the wrong decision for our veterans.” 

[Also: POLL: What's next for VA's EHR plan?]

Shulkin’s goal was to support the VA health system by creating private partnerships, which will help deal with those long wait times and underperforming VA medical centers.

However, Shulkin wrote that the VA has become “entangled in a brutal power struggle” between those who want to improve VA healthcare  -- and those who want to move it to the private sector.

“They saw me as an obstacle to privatization who had to be removed,” he wrote. “These individuals, who seek to privatize veteran health care as an alternative to government-run VA care, unfortunately, fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.”

[Also: Shulkin doubles-down on EHR modernization as price tag swells]

While many reports have hinted at the issues Shulkin blasted in his OP-ED, this is the first time he’s broken his silence. And although Trump has fired other cabinet members via Twitter -- think former White House Chief of Staff Reince Preibus and former Secretary of State Rex Tillerson -- but they’ve remained relatively silent despite the rumors surrounding the conditions of their removal.

Shulkin said he plans to “continue to speak out against those who seek to harm the V.A. by putting their personal agendas in front of the well-being of our veterans.”

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

Less than a month after its announced partnership with Allscripts, enabling physicians to order up transportation for their patients directly from their electronic health record, Lyft announced that it is also partnering with Acuity Link, whose platform connects ambulatory and acute providers with non-emergency medical transportation options.

Acuity Link's dashboard, which can coordinate rides for varying levels of care and modes of transportation, from critical ambulance transport to outpatient transit, will now also support Lyft's ride-hailing functionality.

The integration will allow medical care providers in any health care setting to schedule one-time or recurring non-emergency transportation for inbound or outbound patients, officials said.

[Also: New BCBS Institute working with Lyft, CVS, Walgreens to tackle social determinants]

The companies noted the new partnership could be especially useful for skilled nursing facilities and nursing homes needing to coordinate transportation, pointing out that many of those patients usually get transportation via wheelchair van services, as most ambulance companies don't provide medical transportation for ambulatory patients.

"Prior to Acuity Link, many ambulatory patient transports were performed through a taxi voucher system, which historically has been poorly serviced, inefficient, non-transparent and costly to all stakeholders," said Alex Theoharidis, CEO of Acuity Link, in a statement.

[Also: Allscripts inks partnership with Lyft as healthcare ridesharing race heats up]

Adding Lyft to the company's platform now enables it to offer logistics for "all modes of transportation into any health care setting," he said.

"Because of this joint effort, we're able to reach more passengers to ensure they're able to get to and from important medical appointments as we work to cut the healthcare transportation gap in half by 2020," added Gyre Renwick, VP of Lyft Business.

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

The acronym for chief information officer is perhaps the last remaining link to the role CIOs have historically played.

"Today's CIO is no longer an engineering expert provisioning hardware and software," said John Halamka, a longtime holder of that title at Boston's Beth Israel Deaconess Medical Center. "The CIO broadly communicates, convenes governance groups and supports innovation."

Indeed, the role is changing and CIOs — and other IT pros as well — must keep pace with new skill sets to thrive in their careers.

The CIO's third wave

As Phoenix Children's Hospital Chief Information Officer David Higginson sees it, there have been three ages of the CIO so far in U.S. healthcare.

"In the '80s and '90s it was kind of a plumber type person who got the network working, got the servers running, got the emails going, and that was their job," Higginson explained in an interview at HIMSS18. "Next, in the 2000s, we got into having great big budgets and being tasked by the organization to 'Go make this thing happen.' I think a lot of CIOs today did really well in that project management, system implementation-type field."

Those first and second waves were critically important to the digitization of healthcare but they are now effectively over at all but small and rural providers.

"The potential role for the CIO is to be the digital transformation person who's going to understand what's going on with business and then apply technology to get something out of it."

David Higginson, Phoenix Children's Hospital

Hospital technology leaders, in fact, have moved beyond desktop support and implementation to an era of innovation and constant information knowledge, said Sam Hanna, Chief Innovations Officer at PricewaterhouseCoopers Industries Integrated Solutions Accelerator.

"Gone are the days of tactical and project management expertise," said Hanna, who is also a professor of healthcare strategy and program director of the Masters of Science in Management of Healthcare Informatics and Analytics at The George Washington University's School of Public Health.

"To be effective, the role requires transformational thinking, real-world innovation experience, and the ability to connect multiple pieces of strategy, technology and people together for better sustainable outcomes," he said.

Technology's third platform

Most health systems in the U.S. have their IT infrastructure in place and operational. But with electronic health records nearly ubiquitous, the next charges are connectivity, interoperability, optimization and innovating on top of the digitized platform to further strategic goals.

"We're moving toward more of an information science," Higginson said. "All that effort and all that money we've spent getting data into the system – now what are we going to do with it?"

Perhaps not coincidentally the third wave for CIOs comes at the same time as what analyst house IDC described as the Third Platform. Built on the four pillars of digital transformation big data and analytics, cloud computing, mobile and social (otherwise known b as SMAC for social, mobile, analytics and cloud), IDC predicted that the Third Platform will fuel innovation for the next two decades, in healthcare as well as other industries, of course.

"Today's CIO is no longer an engineering expert provisioning hardware and software. The CIO broadly communicates, convenes governance groups and supports innovation."

John Halamka, Beth Israel Deaconess Medical Center

As hospitals move toward information science and embark on digital transformation those overarching trends, effectively running on the Third Platform, will further change CIOs' jobs along with the very nature of the IT shops they spearhead.

"The modern CIO procures services, often from cloud providers, based on business requirements," Halmaka said. 

Going out to the cloud for analytics, clinical decision support, EHRs, not to mention a raft of mobile apps and social networks, might seem like something everybody does nowadays but it's still a radically different model than IT departments packed with software architects and programmers building proprietary programs or keeping massive databases and enterprise apps up and running.

"The potential role for the CIO is to be the digital transformation person who's going to understand what's going on with business and then apply technology to get something out of it," Phoenix Children's Higginson said.

Hanna added that it is imperative technology executives are able to lead an IT team that works much like a think tank within hospitals to drives innovation.

"The skills," Halamka said, "are more aligned with sociology and business school training than technology."

What's next? 

As chief information officers and hospitals turn their focus from technology to information, the CIO role is evolving into a full-fledged executive charged with generating revenue and scaling the digital business.

Indeed, a new type of executive that builds on traditional CIO skills is emerging to meet that demand. Sometimes that means changes in title, such as chiefs of innovation or transformation – or new mashups such as chief information and analytics officer or, in the case of David Chou of Children's Mercy Kansas City, chief information and digital officer.

Chou explained that the CDO role is to be a strategic agent with "business insight, change energy and a more explicit transformational focus," than more traditional IT leaders, responsible for building and maintaining infrastructure and networks. 

"This shift necessitates big changes in strategy, culture, organization and competency that extend beyond the IT organization to encompass all business functions," Chou said. 

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

Just two months after announcing the beta, Apple is now launching its Apple Health Records feature into the wild, the company announced today. The feature will aggregate existing patient-generated data in a user's Health app with data from their EHR — if the user is a patient at a participating hospital.

In addition to the 12 health systems announced with the beta, 27 more are ready to launch the service, for a total of 39. Anyone with an iPhone and iOS version 11.3 will be able to download the patient-facing side of the feature by updating the Health app in iOS.

Stanford Medicine, Scripps, NYU Langone Medical Center, Partners Health Care, Ochsner Health System in New Orleans, Vanderbilt University Medical Center, and Duke University Medical Center are among the hospitals joining today. Apple previously announced Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.

[Also: Do Apple's recent hospital deals signal industry shakeup ahead?]

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

In the blog post, Apple detailed the experiences of two clinicians who have been using the system: Dr. Robert Harrington, cardiologist and chairman of the Department of Medicine at Stanford, and Dr. Paul Testa, CIO at NYU Langone Medical Center. 

[Also: Apple reveals AC Wellness medical centers to focus on patient experience and population health]

Of note, Testa has adapted the system to include Apple Watch notifications for 35 physicians at NYU, who can set the EHR in advance to send particular lab results to the watch face, so they can respond quickly to patients who need care most urgently.

Apple's long-awaited announcement of the health records tool in January sparked a healthy debate in the digital health community about whether Apple could succeed where others have failed in bringing patient's EHR data to their own smartphones. Time will tell, but the number of hospitals and clinics participating — which number in the hundreds when you account for the size of some of the participating health systems — bodes well for the success of the experiment.

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

The National Quality Forum's Measure Applications Partnership is calling for reforming quality measurement to ensure that it is meaningful and of minimal burden for clinicians and providers at inpatient, outpatient and long-term care providers.

MAP is following up on its 2017 guidance this year suggesting that CMS remove 51 measures from federal programs. These new reports on setting-specific programs follow the release this past month of its final measure recommendations for 35 performance measures under consideration.

Specifically, its new suggestions try to thread the needle between jettisoning measures from federal quality programs while also maintaining the need to encourage optimal care across the board and driving improvement for certain low-performing providers.

[Also: Meaningful Measures specifics emerge: CMS program will track 18 areas]

When it comes to hospitals, MAP said CMS should focus on getting rid of measures that can have unintended consequences, such as encouraging unnecessary treatment. Instead, measures should be emphasized that are easily implemented and can be applied across care settings, especially those that can be used for internal quality improvement efforts.

For clinicians, the group points out that many of the measures that are most meaningful also have a high measurement burden. There could be adverse consequences, experts say, if those are deprioritized compared with lower-burden measures that are less challenging to report. MAP said outcome measures are preferable, and supports composite ways to track performance. Given the diversity of clinician programs, MAP said there's a need for a wide range of measures applicable to providers, their specialties and their patients.

The long-term and post-acute care space was also explored, and MAP told CMS it should consider alignment of measures within and across programs in criteria for removing measures. Measures removed from one program due to a low-performance gap should be considered for removal in other programs, officials said. Those measures reporting the incidence of infections with very low incidence rates should be evaluated for their implementation cost relative to their expected benefit, according to the report. MAP also suggested maintaining measures with specific applications to a unique setting, such as home health.

NQF and MAP are focused on "getting to high-value, meaningful measures to improve care and outcomes for our nation's 55 million Americans who rely on Medicare,” NQF CEO Shantanu Agrawal, MD, said in a statement. "These latest recommendations are about getting to actionable, meaningful information for patients and clinicians while minimizing unnecessary burden for reporting and using quality improvement measures."

The group is a public-private partnership, comprising 150 experts from 90 healthcare organizations, that offers the U.S. Department of Health and Human Services guidance each year on the quality and efficiency measures to be used in various payment and public reporting programs.

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

In a recent Harvard Business Review article, two prominent healthcare experts call for fixing what is wrong with electronic health records. And they find a lot wrong. 

As they see it, if an array complexities were eliminated, it would not only alleviate physician burnout, it would also dramatically improve healthcare.

Robert Wachter, MD, who heads the Department of Medicine at the University of California, San Francisco, and Jeff Goldsmith, national adviser to Navigant Consulting and an associate professor of public health sciences at the University of Virginia, collaborated on the article.

[Also: 'Digital Doctor' Robert Wachter changes his tune, sees real progress in digital health]

"Clinicians are spending almost half their professional time typing, clicking and checking boxes on electronic records," they write.

EHRs, they said, "can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians."

Mashing up functions such as charting, clinical ordering, billing/compliance and quality improvement inside the EHR has been a disaster, they argue.

Why? "Because the billing/compliance function has dominated."

[Also: EHR usability not just a pain point for doctors: It can harm patients too]

Wachter and Goldsmith note that dropdown menus, data input by typing and navigation by point-and-click are not working.

"These antiquated user interfaces are astonishingly difficult to navigate," they write. "Clinical information vital for care decisions is sometimes entombed dozens of clicks beneath the user-facing pages of the patient's chart."

The authors call for a revolution in usability – one in which care of the patient is primary.

"Typing and point-and-click must go," they say.

Instead, Wachter and Goldsmith favor voice- and gesture-based interfaces – noting that using a keyboard and mouse is not only clunky but is also unsanitary.

There's much more to their vision: They suggest roles for AI, groupware, patient portraits, decision rules, data visualization, voice commands, alert systems and improve clinical workflows.

"Today, one can see a path to turning the EHR into a well-designed and useful partner to clinicians and patients in the care process," they write.

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

George G. Glenner Alzheimer's Family Centers has partnered with healthcare startup Seqster to provide access to its health data platform with the aim of improving the Glenner Centers' care coordination and decision-making.

The platform lets individuals aggregate and control all of their available health information, including electronic health record, wearables, ancestry and genomics data. The idea is to let patients and their families better navigate healthcare treatment and share highly valuable personal and family health data with providers and researchers.

The Seqster platform currently connects with more than 1,000 healthcare provider organizations composed of more than 2,000 hospitals and clinics nationwide, with additional providers still coming online.

[Also: Here's what to expect at the upcoming HIMSS Precision Medicine Summit]

To use the platform, a user connects via a website or mobile app to healthcare organization patient portals, wearables accounts, ancestry services accounts and genomics services accounts by selecting the organization or service then entering account credentials into the platform. The platform pulls together the data from all the organizations and services into one database, allowing providers, researchers and family members access to the valuable information on the Alzheimer's patient.

In this way, providers can better plan for the care of the Alzheimer's patient, better plan for the care of family members (who retain access to the data throughout time) who may get Alzheimer's down the road, and allow researchers access to a treasure trove of data that can help them in their fight against Alzheimer's.

"Our aim was to empower individuals to take full ownership of all of their health data, understand it better, and share it with others on their own terms," said Ardy Arianpour, Seqster's CEO and co-founder. "I see an immediate need for better ways to support day-to-day decisions as well as a longer term need to preserve and pass on valuable data to future generations for breakthrough discoveries."

[Also: Intermountain Healthcare building 'GeneRosity Registry,' a global DNA database for genetic discoveries]

According to the Alzheimer's Association, more than 5 million people are currently diagnosed with Alzheimer's disease in the United States of America. In San Diego, home of Glenner Centers, 65,000 people live with Alzheimer's disease and more than 200,000 San Diegans are caring for a loved one with Alzheimer's; the disease is currently the third leading cause of death in San Diego, according to the Alzheimer's Association.

The mission of Glenner Centers is to provide high-quality adult day care and support services to families affected by Alzheimer's, through innovative day care programs, family support, case management, crisis intervention, and family and community education, advocacy, and information.

Through the new health data platform, the provider offers its participants and families an additional benefit and service that improves how they navigate their care experience, including instant access to medical record data alongside fitness, wellness, genomics and ancestry data, officials said.

"I had the opportunity to understand from the technology standpoint something I had not realized until Ardy had explained it to me: Just like people have wills and property and money passed to their family, this health information does not transfer on to future generations," said Scott J. Tarde, CEO and executive director of George G. Glenner Alzheimer's Family Centers.

"And that information is valuable. It opened my eyes to understanding how important that is."

With regard to Alzheimer's and the research opportunity that needs to be explored and how valuable that unidentified data is to researchers, being able to preserve that information and giving the option to let researchers access it is a valuable service for Glenner Centers patients and their families, Tarde added.

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

DrChrono, developer of electronic health records, practice management, revenue cycle and other ambulatory software for Apple devices, is introducing leasing bundle plans to help medical practices replace their outdated computer hardware with new Apple machines.

DrChrono says it's the first such hardware concierge from an EHR company, and it aims to help ambulatory providers modernize and personalize the technology to their particular needs. There are three "bundles" – one aimed at small practices, one aimed at large practices, and one custom package designed around current and future hardware needs, officials said.

The bundles include MacBook Pro, iPad Pros, Apple TV and Airport Extreme and in some cases, devices such as iPhones and Apple Watch.

[Also: Drchrono debuts specialized EHR for urgent care practices]

The fact that so many physician practices are still equipped with older, legacy software and outdated hardware isn't just a challenge for physician workflow and productivity. It can also be a security risk. Outmoded hardware can also adversely impact the physician-patient experience, DrChrono points out, noting that modern mobile tools can help improve the face-to-face interaction between patients and doctors.

Cost is another benefit, said Jim Griffin, president and chief operating officer of Direct Orthopedic Care, a multi-state Orthopedic Urgent Access Clinic, who said the bundles' monthly lease payments are preferable to the large capital expenditures for hardware that often come with growth.

"That is important for us as we’re currently running eight clinics and will be opening another 10 locations in the next 12 months," Griffin said in a DrChrono news release. "This offering is the clinic-in-a-box for software and IT that we’ve been looking for and will make a big difference as we scale."

The leasing program allows for medical practices to upgrade on a timely schedule and keep the practice up-to-date, according to DrChrono, which offers refresh cycles every one, two or three years.

"Physicians should have the best tools at hand," said Daniel Kivatinos, COO and co-founder of DrChrono, in a statement. "Clipboards, paper, COWs, DVDs and fax machines are not efficient; physicians only have so much time in a day and shouldn’t have to deal with antiquated tools that slow them down. Everything should be at the fingertips of a doctor when they need it digitally."

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

The Illinois Rural Community Care Organization will implement HealtheIntent, the big data and insights platform for population health management from Cerner.

The group will deploy the technology across its accountable care organization to coordinate care for Medicare patients across the state.

"In order to move the needle forward in how we provide care for the Medicare patients of Illinois, we need to work with a health IT company that can take all our clinical and financial data and make it valuable," said Pat Schou, executive director, Illinois Critical Access Hospital Network, in a statement.

[Also: Health Network of Missouri to deploy Cerner population health management platform]

Schou added that the ACO expects the technology will help doctors and nurses at member hospitals across the state feel confident in their decision making.

Comprehensive and comparative reports with information on the care individual patients receive, and the overall health of our patients, make it easier for the ACO to develop strategies needed to improve the delivery and cost of care, she said.

Cerner HealtheIntent analyzes medical data across platforms and is expected to help IRCCO clinicians identify ways to engage people beyond the hospital setting, the better to manage health outcomes.

"IRCCO is rising to the significant challenge of providing high-quality healthcare and services, while reducing overall costs for individuals and rural communities across the state," said Cerner President Zane Burke in a news release. 

Cerner technology will be deployed across IRCCO's ACO, which includes 24 member hospitals and four independent provider practices that serve 20,000 Medicare patients across Illinois.

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

The U.S. Department of State has released a request for information for a new electronic health record last week, stemming from a failed joint EHR implementation with the Coast Guard.

The Coast Guard had attempted to share a hosted EHR with the State Department, known as the Integrated Health Information System, or IHiS. But the agency terminated its contract with Epic in 2016 due to various system irregularities, increased costs and technical complexity.

At the time, Coast Guard officials determined there were significant risks to continuing IHiS and pulled out of its contract. The Coast Guard has been operating on paper records ever since. Although, officials put out an RFI for an EHR in 2017 to start a new project from scratch.

[Also: Coast Guard seeks new EHR vendor after failed Epic implementation]

The State Department is now working on its own to implement an EHR, which would support the agency's healthcare program for its department and U.S. government employees serving abroad.

The agency is also looking for shared services capabilities with other federal agency EHRs, like the Department of Veterans Affairs and Department of Defense. Cost is also top-of-mind in the RFI, as is risk. Officials are also requesting information for a phased deliverable approach.

[Also: Coast Guard's abrupt termination of Epic EHR rollout prompts House hearing]

The Coast Guard's use of paper has been chastised by Congress and the Government Accountability Office – which called its program a "debacle" in January. Responses to the RFI were due May 2017, but so far there's been no movement.

DoD is currently in a planned assessment stage for its own Cerner EHR implementation. Roll-out to other agency sites should begin by late spring. As for the VA's EHR project: Without former VA Secretary Shulkin, it's uncertain when the contract with Cerner will be signed.

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

Physicians' Clinic of Iowa has decided to switch from its current electronic health record to the eClinicalWorks' new cloud-based V11 EHR to help its 84 providers better manage the demands of value-based care.

Cedar Rapids-based PCI, which is one of the biggest private specialty medical groups in Iowa, will move from its existing Greenway platform in favor of eClinicalWorks, whose V11 system it hopes will help streamline efficiency and communications among providers and patients do better with preventative care.

[Also: eClinicalWorks CEO Girish Navani: Our next EHR will be like a Bloomberg Terminal]

For instance, Eva, eCW's virtual assistant offers a voice-activated way for physicians to interact with the technology conversationally. And telehealth consults enabled by its healow technology can offer patients expanded access to care.

The V11 platform, which has been available for just over three months, focuses on interoperability, according to eClinicalWorks, enabling connection with other vendor systems participating in CommonWell Health Alliance and Carequality.

"Not only does eClinicalWorks V11 provide a wealth of convenient patient-focused features, it links patient demographics and medical records to insurance, billing and claims data," said Physicians' Clinic of Iowa CEO Michael Sundall, in a statement. "These features are very appealing to PCI as we move forward with our next generation EHR."

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

Vanderbilt University Medical Center has developed a voice assistant for caregivers to use navigating the hospital's Epic electronic health record.

The new tool processes requests using natural language processing and understanding technology, and not just macros, officials say – noting that it could represent an important paradigm shift in how providers interact with their EHRs in more natural and intuitive ways.

The name of the voice assistant is V-EVA, which stands for Vanderbilt EHR Voice Assistant. The Vanderbilt University Medical Center Department of Biomedical informatics and Health Information Technology Innovations developed it.

[Also: Can the EHR be fixed by eliminating typing and clicking?]

"The idea to develop an in-house voice assistant came from the general frustration we heard from users about the difficulty navigating the EHR to find relevant information," said Yaa Kumah-Crystal, MD, eStar Core design advisor, assistant professor of biomedical informatics and assistant professor of pediatric endocrinology at Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt.

"There is a lot of information foraging that occurs in the EHR, although users often know the precise pieces of data they need to understand a clinical picture," she said.

Depending on how an EHR is organized, it can be a taxing process to click and scroll through multiple windows and panes to find an answer. Vanderbilt staffers wondered, wouldn't it be nice to just ask for what you want and have the answer given back to you?

[Also: Natural language processing tools take aim at value-based care through risk-sharing programs]

"The idea for voice user interfaces and natural communication with technology has existed for some time, initially as science fiction now in the consumer realm," said Kumah-Crystal. "Now we have passed an appreciable threshold in machine learning and natural language understanding technology, and this is an idea whose time has come."

Vanderbilt is working in collaboration with Nuance Communications to leverage their artificial intelligence/natural language understanding platform to help process voice requests. The AI is extremely important to a successful functioning assistant because it enables Vanderbilt to build and configure the system to handle various input request types.

"The Nuance platform also enables us to build out our tools in a HIPAA-compliant manner, which is critical when dealing with this level of patient data and protected health information," said Kumah-Crystal. "We are also working with our EHR vendor Epic in identifying and mapping the information sources to satisfy the queries."

[Also: EHR natural language processing isn't perfect, but it's really useful]

A positive aspect of the meaningful use program is that much of the relevant data Vanderbilt caregivers seek now exists as structured and coded information, she said. Additional innovations, such as the FHIR standard have enabled Vanderbilt to develop the platform in a way that data retrieval can be generalizable across other platforms.

"Aside from the technical work of understanding, processing and retrieving the correct information, we have found that a lot of the work of creating a useful assistant is delivering the responses back in a way that not only answers the users' questions but also satisfies their informational needs," Kumah-Crystal explained.

"This has been one of the primary informatics challenges working on a voice user interface. When searching for information on a screen, the user has the opportunity to skim for information and have intermittent transactions with details by glancing back and forth at the data."

Voice is linear, however. The information is given as a direct reply that will be most impactful when the assistant is "smart enough" to understand the intent behind a user's request. This is where Vanderbilt has had to do a lot of exploration of information theory and learn how best to deliver voice replies.

The voice assistant is designed as a mobile responsive web application. The user launches it through the EHR in the context of a patient. A provider can ask a general question to the voice assistant such as, "Tell me about this patient," and receive a summary of the patient's general demographics and recent encounter information.

If the provider asks, "What was her last weight," he will get a response about the patient's weight and relevant information about a change in the weight trend such as, "Sally is 146 pounds today, she has gained 4 pounds since her last visit 6 months ago."

"We believe information like this is where a voice assistant can shine," said Kumah-Crystal. "It is one thing to relay back data that can be found in the EHR, but the added value in providing a layer of context to the information shared can enhance the transaction. This can also save the provider time since they no longer have to look up the previous values and perform the arithmetic themselves to understand the patient's weight trend."

This is also where the expertise of medical informaticists on the Vanderbilt team who are also practicing providers comes into play. These subject matter experts help think through the users' informational needs and the most concise ways to deliver that information. Instead of simply answering the user's questions, the team seeks to understand the problem the user is trying to solve and aims to satisfy that.

The prototype voice assistant is being tested by a small cohort of users to assess the usability, efficiency and safety of this new workflow. Vanderbilt is performing accuracy and time-to-task analysis to see if this workflow saves time over the standard way of seeking information in the EHR. Vanderbilt also is trying to understand when and where the use of this technology would have the highest yield.

"We think the incorporation of voice assistants in the provider workflow can enhance the delivery of care," said Kumah-Crystal. "One of our testers described the platform like a helpful intern always ready with an answer. User satisfaction and the perception of ease of use will also be essential metrics. People are not very tolerant of failure when they are busy trying to get work done."

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

President Donald Trump ousted Department of Veterans Affairs Secretary David Shulkin, MD, last week, after about a month of reports of agency infighting and that found Shulkin was on poor terms with the President.

While there’s still a lot to be determined for the VA, one of the most pressing issues is Shulkin didn’t sign the contract with Cerner to replace the agency’s legacy VistA EHR system before he was fired.

Shulkin had put the contract on hold for interoperability concerns, but reports said he planned to sign it the week he was fired.

So we asked Healthcare IT News readers what they thought should come next for the VA’s EHR plan, and, somewhat unsurprisingly, the majority of users want to keep VistA in place and improve the platform.

Coming in second, with just over 100 respondents, those users want VA to sign the contract with Cerner.

One respondent said that officials should provide real support for VistA and permit new releases for patches, which they said hasn’t been done for a number of years. The response was echoed by other respondents, which chastised commercial-off-the-shelf products that lack the same functionality as VistA.

[Also: Everybody hates VistA? Not its users]

“Commercial Off The Shelf (COTS) products have never measured up to the VistA at all,” said one respondent. “[There have] been very expensive efforts that have yielded nothing of use, apparently not even a lesson to the VA Management.”

“They have missed the lesson that a subject matter expert and a programmer are a powerhouse of innovation and adaptation that commercial packages cannot match,” they added.

Another user had a similar mentality: “VistA has more modules and covers more of the hospital day-to-day and more health-centric than any billing oriented EMR.”

[Also: Poll: Choosing Cerner for VA wasn't a surprise, but not necessarily the best call]

As Healthcare IT News reported in May 2017, while Congress and agency officials have repeatedly chastised the use of the legacy system, VistA users are relatively happy with the system.

When compared with private sector user complaints about clunky EHRs, VistA users have the exact opposite reactions.

Most respondents spoke to not only the usability, but also worried the features required for veteran health concerns aren’t standard with COTs platforms. And those who want to keep VistA in place said they feel hiring programmers to support and repair VistA will be much more cost-effective.

Considering that EHR rollouts are primarily successful only with user buy-in, their arguments aren’t far-fetched.

Those users in favor of dumping VistA and the Cerner contract suggested Epic or a requirement of HL7 FHIR standards to ensure interoperability. Arguably, both Epic and Cerner employ the standard in its platform.

As the VA is currently operating with Department of Defense DoD Undersecretary of Defense for Personnel and Readiness Robert Wilkie as acting secretary of the VA, the future of the Cerner contract is undetermined.

A Cerner spokesperson said Cerner defers to the VA for information on the status of the contract.

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

Jonathan Bush, the voluble co-founder and CEO of athenahealth, is overhauling the company he founded with Todd Park in 1997.

In the next 12 to 24 months, he and his team will have completely deconstructed athenahealth into a set of standalone micro-services that will result in having many more products than the company offers today, he told Healthcare IT News. The shift will also allow many other people to make products.

As Bush sees it, the change will render obsolete buying a complete stack – database, patient directory, provider directory, order sets, procedure codes, diagnosis codes.

And there’s more shaking up to come.

Athenahealth debuted Epocrates Connect, an athenahealth mobile app in March at HIMSS18, for instance. The system uses machine learning and language processing to give providers information and help coordinating patient care.

It's likely to help physician burnout, said Bush.

[Also: Athenahealth CEO Jonathan Bush shares his evolving dream of innovation]

"Part of the reason for the increasing burnout rate is the replication of pointless tasks across the system," he said.

"You have all these isolated stacks of the same information on people," he added. "Maybe one’s at the insurance company. One’s at the hospital. One’s at the surgical center. Every time someone does something, that patient is replicated and shipped off somewhere and gets into a queue somewhere else."

As Bush sees it, it would be better to have everybody looking up the same person in the same place.

[Also: Athenahealth to show new tech to ease burden on doctors at HIMSS18]

"Nationally, there is no interoperability," he said. "You’re just working off a platform. Everybody is operating on the same service."

He points to Amazon as a company that serves as a platform for lots of people who are not only competitive with Amazon. "Everyone expects to operate that way," he said. "Certainly, it's what Apple expects."

Bush is buoyed by the recent healthcare moves by Apple, Google and Amazon.

"The likes of Amazon and Apple are pulling up seats to the table and they’re speaking our language – talking about cloud-based platforms, patient engagement, data accessibility," he wrote in a March 23 post on LinkedIn.

[Also: Next up for EHRs: Vendors adding artificial intelligence into the workflow]

"It's exciting for an antiquated industry like healthcare," he explained. "We absolutely need to better loop patients into the cycle of healthcare and there's great opportunity for big tech to splash here – and splash big."

Is Bush remaking the athenahealth? Yes, somewhat, he said.

"I'm not remaking the vision or the mission. But I'm adding a business model and I’m remaking the tech deck."

Bush is also changing the operating model of the company, he said, which is "going through a painful, confusing, marvelous change."

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

About five years ago, Centegra Health System, a three-hospital system in northwest Chicago, implemented McKesson Paragon as the organization's electronic health record. This included using the EHR in the provider's emergency departments.

But this caused various issues in the emergency department within just a few weeks of go-live because the EHR was not efficient for use in EDs, said Daniel Campagna, MD, emergency department medical director and IT director of emergency services at Centegra Health System.

"These inefficiencies caused our processes to slow to a crawl," he recalled. "Speed means everything in emergency care, and due to the system not being aligned with the flow of the emergency department, it caused all of our quality metrics to greatly suffer. The inefficiencies of Paragon forced us to go back to a partial paper process because our clinicians just couldn't use it."

[Also: ConcertoHealth replaces 73% of face-to-face visits with e-consults]

Centegra Health quickly realized it needed an EHR developed specifically for the ED – one that could meet the demands of the department's unique environment. The health system currently sees an average of approximately 70,000 patients annually in the emergency department across all three hospitals, and to best treat them in a timely manner, physicians and nurses must be as efficient as possible.

Centegra turned to T-System, a vendor of emergency department information systems, specifically T-System EV, an emergency department electronic health record. Because it was developed for the emergency department, the EHR takes into account the unique aspects of patient care in the department.

"T-System is geared toward rapid documentation and computerized physician order entry, and it gives nurses the ability to efficiently and effectively care for patients," Campagna said. "Again, speed is the name of the game in the emergency department, so any documentation solution not built for the department slows down processes and adds risk to what we do."

The emergency EHR has an innovative way of documenting the patient record where it uses circles and backslashes to generate a story of the history and physical exam, Campagna explained.

"It is incredible how the system offers efficient documentation while also providing a complete picture of the care the patient received in the emergency department," he said. "Our physicians, nurses, PAs and techs use the system for patient care."

The emergency EHR is linked with the hospital's inpatient EHR from McKesson and interfaces with a PACS system and laboratory system, importing imaging studies and lab results.

As a result of using the new emergency EHR technology, the health system has seen a 64 percent reduction since 2016 in its door-to-doc times, from an average 67 minutes to 29.7 minutes.

"Because T-System functions perfectly within the flow of the emergency department, our clinicians can document care quicker, and in turn are able to spend more time talking with and caring for patients, instead of spending a lot of time in front of the computer screen documenting care," Campagna said.

"The documentation method allows our clinicians to more efficiently care for patients, which reduces the overall wait times, allowing patients to go from entering the ED to seeing a physician faster," he added. "And we've seen anecdotal evidence of patients being more satisfied with their care because they are seen by a physician faster."

Combining advanced technology with improved triage processes has truly made the largest differences in reducing the time it takes patients to see physicians, he added.

What's more, Centegra Health has achieved a reduction in its left-without-being-seen rate from 2.1 percent in 2016 to 1.1 percent in 2018. The left-without-being-seen rate is a percentage of the patients who register in the emergency department but leave on their own volition prior to a medical screening exam from a qualified provider.

Sometimes they leave because their pain subsides or they begin to feel better, but often patients leave because the wait to see a physician is too long. Door-to-physician times and inefficiencies are huge drivers in the left-without-being-seen rate.

"Once we installed T-System EV, we saw a reduction in the left-without-being-seen rate because we could treat patients faster," Campagna said. "This metric is also tied to how clinicians are able to spend more time with patients and less time needing to document. Again, speed and efficiency are the largest and most crucial elements in the ED, and by being more efficient, we can see patients faster."

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