Oregon-based St. Charles Health System go-live with a $79.5 million Epic EHR implementation on April 7, after two years of planning and development. As EHR projects are some of the most challenging tech launches and Epic is known to be a complicated system, the planning stage was crucial to the project.

Before signing with Epic in 2016, St. Charles was running on two platforms: one for inpatient and the other for ambulatory services. EHR Project Director Chad Cagnolatti said that due to the organization’s strategy to have a more fully interoperable system, “Epic was a natural choice in that objective.”

The health system leaned on the Epic community in the region, as it’s “very collaborative,” said Cagnolatti. From the beginning, the implementation team met with health leaders in the area with Epic experiences to pull cooperative lessons learned from Epic implementations.

“We took those lessons learned and specific concerns to use in our organization,” said Cagnolatti.

User buy-in

To start, the health system spoke extensively with caregivers and providers who asked for a more robust, deeper platform that “could provide more efficient, more effective, real-time data,” said Cagnolatti.

In fact, much of the planning process came from these conversations with caregivers, explained Cagnolatti. They wanted a solution that served all avenues of care and supported interoperability, and officials shared the same goal.

[Also: Here's why 9 systems made planning for EHR go-lives a priority]

Once the mission was established, the first step for St. Charles was to build its implementation team.

“We screened and vetted over 850 candidates and hired an implementation team of 85 caregivers to design, build and test the Epic system,” said Cagnolatti. “We had the team in place by August 2016: a month earlier than planned.”

Once the team was in place, work began on best practice system workflows, which were shared with caregivers and stakeholders across the organization. Cagnolatti explained the idea was to make those decisions on the best fit for users, which were then adopted “wherever and whenever” it was needed.

In total, there were “six months of testing and four months worth of training and operational readiness, and now we’re just days away,” said Cagnolatti.

User training

Given the complexity of the Epic platform, user training is crucial to the success of the implementation. And Cagnolatti said that St. Charles approached training in a comprehensive way, as the organization really saw the “importance of thorough and relevant training for all care providers.”

In fact, Cagnolatti said the health system established a policy that everyone who would use the EHR in their workday would be required to complete all training. As a result, the team gave that staff access to the EHR, and “everyone was expected to complete role-based training.”

[Also: Epic go-live at UMass Memorial a masterclass in getting staff behind an EHR switch, CIO says]

St. Charles employed the strategy and models from Epic, and all providers were trained by peers, allowing training to be more relevant to the user. And Cagnolatti said that not only did users say they felt training was more beneficial, they were also able to reduce the amount of time in training classes.

And training was provided to users at a wide range of available hours to fit staffing schedules.

One of the biggest challenges was making sure there was a standard method for work processes across the organization, Cagnolatti explained. “It’s a challenge, but a huge opportunity to improve.”

But readiness and planning have been key to planning for Saturday’s roll-out, which Cagnolatti said they’re prepared to handle.

“An undertaking like this is a transformative paradigm shift for an organization,” said Cagnolatti. “It really changes how the organization does business and changes their underlying fabric and philosophy.”

So the team has been making sure everyone is ready across all service lines. By checking for readiness, Cagnolatti said they can determine what they’re ready to take on.

“I can’t overemphasize taking the time to plan for staff and make way room for the time and effort that it takes collectively across the entire org to be successful,” said Cagnolatti.

But that extra time, Cagnolatti hopes will allow the organization to leverage the power of data through the interoperable, single EHR system to improve care delivery models and help the organization manage the population more effectively.

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

Kern Medical, a 222-bed acute care teaching hospital in Bakersfield, California, will roll out a Cerner Millennium EHR. The hospital also tapped Cerner for its HealtheIntent, a big data and insights platform for population health management.

Kern Chief Medical Officer Glenn Goldis, MD said in a statement the hospital will use the integrated platform and actionable health data to support improved health outcomes for the health and well-being of the community.

Cerner President Zane Burke added that the software will help Kern provide data across the care continuum. 

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

Kern Medical’s goal is to have one integrated and efficient platform to provide seamless care across the enterprise. The new portal, for instance, will enable patients to access their health information.

Kern Medical is Kern County's only trauma center, the area's only academic training hospital and has an affiliation with the UCLA David Geffen School of Medicine.

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

The Office of the National Coordinator for Health Information Technology unveiled the new ONC Guide to Getting and Using your Health Records, a resource for individuals, patients and caregivers.

The new project aims to enable the patient access goals of both the 21st Century Cures Act and new MyHealthEData announced by the Centers for Medicare and Medicaid Services at HIMSS18.

[Also: Seema Verma rolls out new CMS interoperability initiatives at HIMSS18]

ONC’s Guide to Getting and Using your Health Records offers a list of tips for gaining electronic access to data, gives advice to help patients ensure their records are complete, correct, and up-to-date; and offers perspective on making best use of EHRs, such as sharing records for better care coordination and incorporating apps and other consumer tools.

ONC data shows that half of Americans said they were offered access to an online medical record by a provider or insurer in 2017, and that eight in 10 of those who viewed their health data said it was easy to understand and useful for managing their health.

But nearly half of those were offered access to their data didn't take advantage of it, with many citing a perceived lack of need as one of the reasons for not accessing their record. There are also concerns that some patients don't understand their right under HIPAA to see their own data, according to ONC.

"It’s important that patients and their caregivers have access to their own health information so they can make decisions about their care and treatments," said National Coordinator for Health IT Don Rucker, MD. "This guide will help answer some of the questions that patients may have when asking for their health information."

CMS is participants in the new initiative, along with the National Institutes of Health and the Department of Veterans Affairs.

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

The U.S. Department of Defense and the Coast Guard are partnering to jointly roll out the same electronic health record, MHS Genesis, the agencies said Monday.

The Coast Guard will deploy MHS Genesis to its clinics and sick bays through a single inpatient and outpatient Cerner EHR.

[UPDATE: Coast Guard reveals more details about how it will adopt DoD's $4.3 billion EHR]

Having terminated a failed Epic EHR contract nearly three years ago, the Coast Guard has been operating with pen and paper ever since. The Coast Guard and State Department attempted to work together on the Epic project, but a long list of concerns forced the agencies to abort the rollout.

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

Epic, for its part, said it did everything it could, fulfilled terms of the agreement and the software was ready to go-live.  

Just last week, the State Department put out an RFI for a solo EHR project, which officials said it hopes will have shared services capabilities with other federal agency EHRs, like DoD and the Department of Veterans Affairs.

[Also: State Department puts out RFI for a new EHR]

Both the Government Accountability Office and Congress have berated the Coast Guard for its use of paper records, calling its program a “debacle” in January.

DoD is currently in a planned assessment stage for its Cerner EHR project, but the roll-out is scheduled to continue in late spring. And while former VA Secretary David Shulkin, MD was working on its own contract with Cerner to match the DoD, his removal from office puts that VA contract on hold indefinitely.

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

The U.S. Coast Guard announced on Monday that it would join the Department of Defense on its EHR project to transition the patient records of its service members and clinics to the DoD’s MHS Genesis platform.

The Coast Guard’s needs will be incorporated into the DoD’s $4.3 billion contract with Leidos, rather than signing a direct contract with Cerner -- unlike the Department of Veterans Affairs plans to contract directly with the vendor.

DoD officials are uncertain whether the contract ceiling will need to be raised to accommodate the Coast Guard’s requirements. The Coast Guard is about 6 percent the size of DoD, according to Rear Adm. Michael Johnston, the Coast Guard’s director of acquisition programs.

[Also: Coast Guard to deploy Cerner EHR in DoD partnership]

Johnston said the Coast Guard will integrate its rollout into the DoD’s deployment schedule and will lean on those lessons learned to ensure success. And while there’s currently no timeline, officials estimate deployment will happen in a fraction of the time than the DoD.

“They already have those separate teams that are working on where are those soft spots as far as network and security,” Johnston said during Monday’s press call. “We’re working with getting those same bodies and those same experts rolled into our CIO shop.”

“We’ll have them deploy to one or two sites like we did, do an evaluation and make sure that the software baseline and the technology, as well as the infrastructure, meets the needs of the users, and our intention would be to enfold them into the deployment strategy as appropriate,” said Stacey Cummings, the lead acquisition official for Genesis.

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

The partnership will move the Coast Guard from paper records, which the branch has been using for nearly three years since it ended its contract with Epic. The Coast Guard spent more than $60 million over seven years on an Epic contract, which never took off. The contract was canceled in 2015.

While the agency plans to rollout out its EHR following the same schedule as the DoD, questions remain over cost, initial sites and how the Coast Guard will transition all of its paper records to the new system.

But the Coast Guard is confident in its choice, having performed a thorough analysis of requirements and alternative platforms. The branch put out an RFI last year to assess its options, and its acquisition officials determined that adopting MHS Genesis was the best choice.

“Our assessment is that our requirements are nearly 100 percent the same as DoD’s,” Johnston said. “We’ll pay for the services that we get, and we’ll partner with DoD to clarify how that best works in their strategy.”

[Also: State Department puts out RFI for a new EHR]

Cummings said that they’ll consider the needs of the Coast Guard and assess the platform as they’ve done throughout the pilot process.

“As we’re going through the process, if we find that there are areas where the Coast Guard has a better way of doing things or if there is uniqueness that needs to be addressed in Coast Guard facilities, we’ll consider them just as we would any of our customers,” Cummings added. “We have the processes in place to look at those from a governance perspective so that everyone benefits from that standard workflow that we can then push across our entire enterprise. That’s important because we all have users that move frequently from site-to-site more frequently than you might see in a commercial environment.”

But a DoD notice published on Monday appears to note that the Coast Guard partnership will add complexity to its Leidos contract.

“Some of the extended capabilities necessary to maintain a single standard solution baseline with the VA and USCG are provided as clinical application services not covered by the existing DHMSM license agreement,” according to the notice. “These CAS capabilities cannot be fully realized unless they are implemented in the Cerner environment.”

Currently, the DoD is in a planned assessment stage, addressing user concerns and ironing out workflows.

Cummings noted that the biggest issues stem from lag-time due to the necessary security needed for the platform. Once users are in, the system runs smoothly, but logins are delayed. Officials are addressing those issues, ensuring that security remains intact.

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

Mercy Technology Services, the IT backbone of one of the largest Catholic health systems in the nation, has launched a new healthcare cloud service designed to meet the needs of the highly regulated healthcare market.

IT execs at the St. Louis-based Mercy said cloud hosting offers efficiency, flexibility and cost-effectiveness that make it preferable to infrastructure-heavy enterprise data centers.

"Healthcare's tech leaders want to migrate to get the cloud's benefits without the cloud's risks, but a good solution has been hard to find," said Scott Richert, Mercy's vice president of enterprise infrastructure. "This is the same equipment I'd buy for my enterprise data centers, with the same high service standard we hold for ourselves. Now there's a way to share enterprise-class cloud hosting with our healthcare community."

[Also: Culture meets history: How Mercy's IT team builds on its roots]

Mercy Technology Services, one of Healthcare IT News' Best Hospital IT Departments, knows firsthand the unique hosting needs of healthcare as the IT shared services arm of Mercy, a 40-plus hospital health system.

Mercy's healthcare cloud is supported by Mercy Technology Services' HIPAA-compliant, SSAE 16-compliant and SOC2-compliant data centers, where it hosts Mercy's roughly 1,200 healthcare applications, including the Epic EHR for Mercy and commercial customers.

Mercy Technology Services will provide the cloud infrastructure for hosting mission-critical apps like the EHR and imaging, as well as business-essential systems like email, file shares or any other healthcare workload.

Mercy is part of the VMware Cloud Provider Program, and Mercy Technology Services' cloud service runs on VMware vSphere, a virtualization platform for building cloud infrastructures.

By leveraging a common cloud infrastructure customers can move workloads between their private data centers and Mercy Technology Services' cloud, and leverage the Mercy Technology Services cloud service for increased flexibility, security and IT agility, officials from Mercy Technology Services said.

The new healthcare cloud and managed services will be available from Mercy Technology Services beginning late spring 2018 and will supplement Mercy's portfolio of IT systems, which includes Epic as a service, backup and recovery as a service, imaging as a service, healthcare analytics and more.

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

Rankin County Hospital District announced that it has rolled out an integrated Cerner EHR to support and improve the user experience for both patients and clinicians. 

Rankin is the second provider this week to sign on with Cerner; Kern Medical announced that it is implementing both Cerner’s Millennium electronic health record and the vendor’s population health management tools. 

Rivals eClinicalWorks and Epic also have customer news this month. Oregon-based St. Charles Madras Hospital completed an Epic rollout while Physicians’ Clinic of Iowa subscribed to eClinicalWorks cloud services.

[Also: Mercy launches healthcare cloud to host EHR, imaging and more for other hospitals] 

At Rankin, Cerner’s Millennium EHR provides the hospital with technology to support doctors, nurses and staff to streamline operations and boost patient care, according to officials. 

Rankin’s new EHR is deployed through the Cerner CommunityWorks model that employs cloud technology to deliver the power of Cerner Millennium, tailored to support the unique needs of community, critical access and specialty hospitals.

CommunityWorks will support the 15-bed critical access hospital as it provides comprehensive care through its emergency services, family practice medical clinic, outpatient lab and acute care.

CernerMillennium will also support improved patient engagement via its new online patient portal, which makes it possible for patients to securely message doctors, schedule appointments, view and settle balances and access their health history.

Rankin CEO Jim Horton called the Cerner rollout “a smooth go-live,” and added that executives and staff noticed an immediate impact at daily revenue cycle meetings.  

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

The federal health IT market is seeing strong growth and will peak at $8.5 billion in 2022, which is being fueled in part by the U.S. Department of Veterans Affairs EHR initiative, according to a new Deltak report.

Health IT is pegged at $6.1 billion in 2018, pushed by both the VA and Department of Defense EHR projects, the report found. VA and DoD spending is expected to peak in 2022, but will scale back spending on existing EHRs as new systems come online.

[Also: Department of Veterans Affairs looks to private developers for innovation]

As a result, federal health IT spending in 2023 is projected to drop slightly to $8.1 billion.

Currently, the Department of Health and Human Services leads in IT spending, and as of 2017, the agency had about 40 percent of the $7.5 billion in government health IT spending. The VA’s spending was about 27 percent, while the DoD came in third at 24 percent.

But the VA’s IT modernization is seeing an increase, as IT spending for the health insurance marketplaces will drop. And HHS spending is decreasing as it goes back to pre-Affordable Care Act spending.

[Also: Coast Guard reveals how it will adopt DoD's $4.3 billion Cerner EHR]

Federal health IT initiatives also are focused on cyber, access and interoperability, and cloud and digital platforms, according to the report.

Former VA Secretary David Shulkin, MD, made the announcement in June 2017 that the VA would transition its legacy VistA EHR to Cerner and the effort has been fueled by the desire to interoperate with the DoD and private health sector. In fact, that contract was put on hold over interoperability concerns.

But the Government Accountability Office expects the near $16 billion project to begin rolling out in June 2019.

Federal health IT spending over the next five years will also be spurred by an increase in Medicare enrollment. However, the VA will still lead in health IT spending at about 40 percent, according to the report.

By that time, DoD will have completed its rollout of MHS Genesis and will share about 27 percent of federal health IT spending at that time. Currently, DoD is in a planned assessment period after completing rollouts to four pilot sites. Further implementations are expected to continue through late spring.

The report authors recommend that contractors looking to join these federal health IT efforts “look for ancillary opportunities to support EHR implementation efforts at DoD and VA.”

These include interoperability solutions with outside healthcare organizations and application development that leverages EHR data, infrastructure upgrades and functional tools not provided by the new EHRs.

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

Just this week, the U.S. Coast Guard announced its plans to join the Department of Defense on its MHS Genesis EHR project. With the Department of Veterans Affairs planning on tapping Cerner as well for its new EHR, it appears Cerner is the preferred vendor for federal health IT needs.

As the State Department just released an RFI for its own EHR project, it calls into question whether it makes sense for the agency to join the Cerner wave, as well. We’re wondering what do you think is the best course of action for the State Department’s EHR plans?

ECRI Institute, through the multi-stakeholder Partnership for Health IT Patient Safety it convened in 2014, has announced a new tool to help electronic health record and other IT vendors assess how well they're keeping safety in mind when designing their products.

The new Insight Culture of Safety Assessment for Health IT Companies is built around a three-part safety vision, officials say: safe design and development, safe use, and safe implementation of IT for safer care.

"Ensuring a strong culture of safety can help avoid costly disruption of business and unwanted legal and regulatory actions," said Lorraine Possanza, program director for the partnership for Health IT Patient Safety, in a statement.

[Also: Patient safety check-up: Promise, progress and a need for vigilance]

She explained that close monitoring of employees' safety-related perceptions and experiences over time, especially comparing teams and departments, can strengthen vendors' safety focus across product life cycles.

The new poll is meant as a program for IT developers to assess their own cultures of safety with questions tailored to their specific organizations, according to ECRI. A secure and confidential survey questionnaire that can allow for development and implementation of "safety-focused action plans grounded in analyses of team members' responses."

[Also: HIMSS EHR Association tackles TEFCA, opioid response, usability and safety]

The tool aims to help vendors evaluate perceptions of safety issues across their different teams and departments; assess the uptake of shared safety responsibilities; gauge the effectiveness of and needs for safety-related training and compare safety values across teams and product lines.

It can also – once enough organizations have participated to enable valid comparisons and organizational confidentiality – help companies contrast results with similar organizations using de-identified comparative data, and identify specific safety areas that may need greater attention.

"As shown in the EHR Developer Code of Conduct, patient safety is a priority of the EHRA and our members," said Sasha TerMaat, a Director at Epic and chair of the HIMSS Electronic Health Record Association's executive committee, noting surveys such as this one offer health IT developers "additional tools for continuous improvement."

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

Miramont Family Medicine, a group practice in Fort Collins, Colorado, has four offices with staff and patients in each location. For physicians, finding the time to be physically present where and when they are needed can be difficult.

John Bender, MD, Miramont's CEO and a diplomat for the American Board of Family Medicine, was looking for a better means to connect with patients and staff when he was in one place and they were in another – a way that would not require a person on the other end to answer a call or otherwise facilitate, especially when a phone call just isn't enough.

[Also: Millennials demand telehealth in a move away from traditional primary care model]

So Bender turned to a telemedicine technology that resembles a robot-like device on wheels with a monitor for a face: Bender's own face appears there when he is communicating with staff and patients at another of the four locations.

Bender and other physicians and staff can control that telemedicine robot, called Beam and made by Suitable Technologies, using a computer or smartphone app. 

At Miramont, the Beams get parked in charging docks near staffers sit.

"I can log in from my computer or phone from wherever I am and drive the Beam around the office for up to eight hours at a time without needing a charge,” Bender said. "Beams have a solid base with wheels that maneuver extremely well so I can navigate small spaces or go over bumps in the carpet. I even use the speed boost often to quickly get from one room to another."

The telemedicine market is considerable, and there are many technology companies that can enable person-to-person telehealth consultations. These vendors include American Well, Avizia, Capsule Tech, Carena, emocha, EpicMD, GlobalMed, MDLive, SnapMD and VirtuMedix.

There's nothing special that others have to do to converse with Bender when he is on a Beam, they just speak with him as they would normally. The audio and video are clear, he said, even when there's a lot of noise in the background.

"It's amazing how quickly the technology itself fades away and you find yourself interacting with those in the room as naturally as you would otherwise," he added.

Bender and his staff started with psychologist, clinical pharmacist and nutritionist consultations for patients in the remote mountain town of Fairplay. Then they expanded to family physician consultations for chronic disease cases.

They have since overseen fiberglass cast removals, presented at weight loss clinics, provided buprenorphine/addiction clinic follow up, and given instructions for kidney infection care, among other things.

"I also regularly use the Beams for acute consults when I'm not onsite, where the PA or nurse practitioner is seeing the patient and I 'Beam in' to assist with medical decision making for a patient I have not previously seen," Bender explained.

"I've also provided tours of my clinics to visitors on either side, checked up on employees, came to a staff member's aid when beckoned, and even handled a surprise DEA inspection of one of our facilities."

Bender said Miramont Family Medicine has seen good results from using the telemedicine technology at its clinics.

"First and foremost, I can be in more than one location at once, which has dramatically improved productivity, efficiency and job satisfaction," he said. "As a team, we can now serve more patients than usual. Our record to date is thirteen patients in one day – patients we had no other way of seeing otherwise and who wouldn't have been seen that day had it not been for the technology."

For patients, the technology expands opportunities to encounter Bender when he is out of town or otherwise would not be available to them. They still come to the clinic where they have lab tests run, X-rays taken, nursing procedures performed.

But with telemedicine, Bender can securely review all charting, vitals and test results remotely while still communicating "face to face" in real time.

He said he would not be able to accomplish this without telemedicine technology or in the same manner just by telephone.

"The technology does not require the person on the other end to have any technology skills, special passwords, etc.," he said. "I just start the session, it's that simple. Also, the ability to move around gives me much more environmental information about what is happening at the location I am remotely visiting than I would ever get in a Skype session controlled by the other user.

Healthcare is a profession that provides a personal service, so it's vital to Bender that he can establish his presence in the location where he is needed. The telemedicine technology, Bender said, adds an extra touch that helps Bender and his staff be more effective at their jobs, and it simultaneously makes patients feel comfortable and secure knowing they're getting personal service.

"There's so much going on in my offices and clinics each day; having telepresence technology allows me to worry less about driving from one location to another and enables me to stay focused on providing quality care," he said. "Whether it's after-hour emergencies or acute care consults in the clinics during normal hours, it is an essential tool."

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

Health information technology can do a lot to improve care processes, drive better patient outcomes and bolster the bottom line. But sometimes – with the right adjustments and a committed all-hands approach to using systems optimally – it can do even more.

That's what IT staff and clinical end-users at NYU Langone Health have shown, with an initiative that modified a module of its Epic electronic health record to help standardize clinical pathways for more effective care and, in turn, save some $13 million. 

Here’s a look at what other hospitals can learn from work NYU Langone conducted. 

Enterprise call to action

The Value-Based Management Clinical Pathway program launched by the health system more than three years ago was envisioned as a way for it to better align its EHR to drive best practices for physician decision-making, the ordering of labs and med and more.

By focusing first on three areas – colon surgery, pneumonia and heart failure – NYU Langone was able to improve patient care and lower costs substantially by reducing unnecessary testing and treatment. It also -- along with other projects focused on paperless registration and bundled payments for total joint arthroplasty -- helped earn itself a HIMSS 2017 Davies Enterprise award.

[Also: HIMSS Big Data and Healthcare Analytics Forum to focus on best practices for leading transformation]

The clinical pathways initiative has its roots larger program at the health system called Value-Based Management, explained Jonathan Austrian, MD, a hospitalist who serves as NYU Langone Health's Epic inpatient medical director.

"That was an enterprise call to action by the dean for us to really look at our processes and ensure we're providing maximum quality and maximum value," said Austrian.

Colon surgery, pneumonia and heart failure were three areas that seemed ripe for improvement, he added: "The first step was to really understand where, clinically, we could do better in any of those conditions. When we saw these deviations from the standard of care, we knew as an enterprise we had to do better."

NYU then formed a collaborative group that included physicians, nurses, social workers, care managers and members from of NYU Langone's IT departement, "who are experts in workflow and the electronic health record," said Austrian. "We also included residents and nurse practitioners. We realized that people was number one: getting the right stakeholders at the table."

Next was to codify a set of best practices for each of those specific clinical domains. For instance, there was a set of recommendations that should be put in place and kept consistent for all colon surgery patients, he said. "And for heart failure, we wanted to be very aggressive and also timely, in giving patients water medicine via IV to get the water out of their lungs quickly."

With those clinical principles agreed upon, the next step was to iron out the processes for ensuring they're adhered to, and identifying the tools that can help support those best practices.

"When we did an environmental scan of different tools within our electronic health record and third-party systems, we really thought the best tool was within our existing EHR – a module called Epic Pathways," said Austrian.

It was a valuable piece of software. But it needed some adjustments to get NYU Langone where it wanted to go with its clinical pathways.

"There was an existing tool, but it frankly was kind of envisioned as more of a nursing tool, and we wanted to create truly interdisciplinary pathways that involved both nurses and providers, so we had to modify some of the documentation tools and make sure it was available for all roles," he said. "Another tweak is we really worked with the vendor to make pathways as simple as possible. We tried to remove some of the extra screens and extra documentation paths. Epic and the developers were supporters of our initiative, and told us some of the ways we could streamline the workflow."

‘A weaning off process’

It wasn't always easy. But one of the strengths of the VBM program was that "we had support of project managers, both in operations and in IT, and our clinical colleagues got very comfortable with those project managers, who are key to making sure projects get off the ground," said Austrian.

On the flip side, those project managers were so helpful that "we had challenges with the transition of really handing over operational oversight of clinical pathways away from the project managers and to clinical leads," he said.

"It was kind of a weaning off process," he said: "'The project manage have to go to other project, they can't continue to run your reports and prepare the dashboards for you. You, as the appointed operational leads, need to use these tools yourself and be able to sustain these interventions.'"

NYU Langone went live with all three pathways in March of 2015, and continues to use those streamlined processes today. It's also expanding its purview: "Our next pathway is going to be CPOE, which was another area that was identified as one that could benefit from an Epic clinical pathway."

Clearly, this was a project worth doing. Beyond the boon to better patient care, the savings were substantial. Between the third quarter of fiscal year 2015 and Q2 of FY17, the health system was able to realize more than $12.9 million in savings from the initiative – about $2.5 million from colon surgery improvements, $4 million from better process for heart failure and $6 million for its pneumonia clinical pathways.

Within those numbers, the savings came from several different areas. For heart failure it was by decreasing length of stay, for instance. But it was also just a combination of not using critical care units as often as had been required previously, and simply making sure patients got their care in a rapid and standardized fashion, said Austrian.

What other hospitals should know: Laser focus

As with so many successful IT projects, Austrian cautioned that this work in not a matter of doing it once and being done. 

"I don't want people to get the idea that you can just implement a pathway and realize these savings. As I said, there was a significant institutional support and push at the highest level. We had buy-in, and we had access to reporting resources and project management resources,” Austrian cautioned. “And it speaks to the strategy of people process and technology for a successful implementation and sustainability."

That said, if hospitals or health systems want to try out a similar strategy for themselves, he offered a few bits of useful advice.

"I would start with pathways for surgeries," said Austrian. "Surgical care tends to be more sequential and predictable. So pathways work really well in those kinds of forums."

Also, "start with the end in mind: What are your goals, where do you see the pathway helping? Is it making sure the patients are getting the right medications? Or is it making sure that things aren't being done to patients?

"One of our outcomes is that patients don't routinely need a nasogastric tube after colon surgery," he explained. "And if they do, that's marked as a deviation. And then our clinical teams can look back – why did that patient require an NG tube, and was it appropriate, and is there an opportunity to help our clinical team continue to improve?"

In general, his advice is to "really keep it simple."

Initially, when the scope of what this project could accomplish came into focus, "there was a lot of enthusiasm about having a lot of outcomes to document on," said Austrian. "But what we've seen over time is that it's best to have a laser focus on those outcomes that we believe are going to be most meaningful to our patients. It's better to start with fewer outcomes, and expand if you're finding that over time and study that other outcomes are more important."

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

If the first half is any indication, April is shaping up to be an active month EHR-wise -- and that holds as true among smaller and community hospitals as it does for massive federal government agencies. 

When Rankin County Hospital District announced that it rolled out an integrated Cerner EHR to support and improve the user experience for both patients and clinicians it marked the most recent move. 

The hospital, in fact, is the second one this week to opt for Cerner. Kern Medical said it is deploying Cerner’s Millennium electronic health record and the vendor’s population health management tools. 

New hospital EHR implementations are not limited to Cerner, of course. 

Last week, for instance, St. Charles Madras Hospital in Oregon said that it just completed a two-year Epic rollout and the Physicians’ Clinic of Iowa subscribed to eClinicalWorks cloud-based EHR services to advance its transition to value-based care. 

The Illinois Rural Community Care Organization last week also announced that it will implement Cerner’s HealtheIntent population health management platform to more effectively coordinate care across its accountable care organization. 

A pair of large federal government agencies also made moves this month: The State Department issued an RFI for a new EHR, after it and the U.S. Coast Guard stopped a joint Epic implementation in 2016. 

The State Department, instead, is now going it alone in picking its next electronic health record while the USCG forged a pact with the Defense Department to implement Cerner under the DoD’s contract.

Although Veterans Affairs embarked on its own contract with Cerner, it’s currently on hold since before the departure of former Secretary David Shulkin, MD, so we asked Healthcare IT News readers what they think the VA should do -- and the majority favor VA keeping and modernizing the proprietary VistA EHR. The poll was open to all readers, not just VistA users, it’s worth noting and it started a contentious debate in the comment section below the article. 

We also posted a new poll asking readers what the State Department should do about its EHR. Weigh in right here.

Back in the private sector, Mercy Hospital in Missouri revealed that it built a healthcare cloud to host EHRs, imaging services, and common apps including e-mail and file-sharing for other hospitals that would essentially become Mercy customers. 

EHR maker Allscripts, for its part, realigned business operations to focus on care coordination and innovation by having the acquired CarePort Health team take over the Allscripts Care Management platform. 

Vanderbilt University Medical Center introduced V-EVA to the world, too. V-EVA, which stands for Vanderbilt EHR Voice Assistant, uses artificial intelligence and natural language processing technologies to help caregivers better interact with its Epic EHR. 

Vanderbilt’s move follows signals that emerged last month at HIMSS18 from EHR vendors Allscripts, athenahealth, Cerner, eClinicalWorks and Epic that they are each working to add AI into the workflow of next-generation software. 

And late last week ECRI Institute unwrapped the Insight Culture of Safety Assessment for Health IT Companies tool and said EHR and other health IT vendors can use it to track patient safety by enabling them to measure developers perception of safety across department and teams. 

Whether April’s momentum continues through the second half remains to be seen but this month has been action-packed so far. 

Munising Memorial Hospital, an 11-bed, critical access hospital in Munising, Michigan, announced Monday that it plans to implement Cerner EHR and related cloud services. 

MMH joins the increasing number of smaller hospitals turning to cloud subscriptions from Allscripts, Cerner, athenahealth, eClinicalWorks, Epic, Meditech and others instead of running and maintaining the software on-premises themselves. 

[Also: New EHR go-lives, RFIs and other interesting moves so far in April]

Black Book Research, in fact, published a report on Monday that found nearly one-third of the 19,000 polled physician practices intend to switch vendors in the next three years and the majority of those are considering cloud services from electronic health record to practice management and revenue cycle capabilities, as well as telehealth, virtual care services and even speech recognition. 

Along with the EHR, Munising Memorial also signed up for Cerner’s new online patient portal, which gives patients the ability to securely message their doctors, schedule appointments, view and settle balances and access their health history.

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

MMH also will employ Cerner’s revenue cycle management technology for billing and tracking financial data. Specifically, MMH will be able to integrate financial data with clinical data from the Cerner Millennium EHR into one patient record to enable staffers to update billing throughout a patient’s visit with the goal of enhancing documentation to both improve reimbursement and reduce errors, the hospital said. 

Munising Memorial CEO Melissa Hall said in a statement that the provider will transition to Cerner’s Millennium EHR in the hospital, doctor’s office and outpatient clinics.

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

Physician practices are looking to improve their electronic health records and many are shopping around for more advanced tools, according a new report from Black Book Research – which sees 30 percent of practices with a dozen or more docs expecting to replace their current system in the next three years. 

They're seeking more customizable and integrated EHRs, with practice management and revenue cycle management, according to the report, which polled nearly 19,000 ambulatory EHR users.

[Also: New EHR go-lives, RFIs and other interesting moves so far in April]

Huge majorities are looking for cloud-based and mobile tools that offer on-demand data and visibility into financial performance, compliance tracking and quality goals, according to Black Book.

Speech recognition capabilities and support for telehealth and virtual care are other top items on practices' wish lists.

The report also finds that most smaller practices are still under-utilizing advanced features such as electronic messaging, clinical decision support and patient engagement tools, and that interoperability is still a sticking point for those providers.

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

"Traditionally, it has been the smaller and solo practices with the highest dissatisfaction ratings for electronic health record applications but we confirmed also that the smaller the practice, the less likely they are to use advanced IT tools and that is where EHR frustration among small practices is generally focused," said Doug Brown, managing partner of Black Book, in a statement.

The poll found that 93 percent of practices use the three basic EHR functionalities most often: data repository, order entry and results review.

"When we look at apples-to-apples client satisfaction among small practices, it's about basic functionality experience," said Brown. "While in large practices, the rating of customer satisfaction is based on that plus a much wider breadth of vendor offerings and client execution from claims management to population health bundled in."

Black Book recently conducted a similar survey focused on consumers, which found that a commanding 91 percent of patients younger than 50 said they prefer tech-savvy practices with advanced capabilities and connectivity.

"The technology expectations of upcoming generations will likely contribute to the gradual demise of independent, solo physician practices if they do not invest and provide what healthcare consumers clearly want," said Brown.

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

The HIMSS18 Global Conference held in Las Vegas, Nevada was once again a delight to attend and exchange thought leadership among fellow colleagues. It seemed that thousands of vendors promoted services and solutions, all with the intent of facilitating better patient care, advancements in research, safer work environments and more efficient organizations.  

At the core of many of these offerings is data, and in some cases vast amounts of Big Data. Patient monitoring systems, wearables, patient reported outcomes, and new research algorithms are just a few of those offerings which transmit large streams of data.  Almost as befuddling to the Information Services executive as attempting to navigate the HIMSS18 vendor floor is what to do with all of this data.  The challenge is multi-faceted and despite the claims of many in the vendor community; not easily addressed.  

As I see it, large-scale data management fits the classic people, process and technology umbrella.  Many vendors indicate the technology component can be easily addressed. Simply sign up to procure large amounts of data storage, either through their on-premise or cloud offering, and you have solved your problem. 

Unfortunately, it’s never that easy.

The challenges associated with marrying the resources and processes to drive measurable and actionable outcomes remains. In addition, the funding of large-scale data management is often unfamiliar territory for many organizations. Consequently, prioritizing budgets for data management is often difficult with other competing organizational requirements.  Engaging operational leaders in order to truly understand the value of these data-related investment requests and holding requestors accountable for the anticipated results is far more difficult than evaluating more traditional investments.  

So, what is an Information Services executive to do with the fan-fare of data-driven innovation lurking just ahead?  

Educate– leadership is often familiar with the attributes and management of basic data repositories, but not entirely sure of the technical and operational intricacies associated with big data.  Areas requiring initial education include back-up and storage expenses, proper tools to liberate the data, how best to secure the data and the opportunity cost of not prioritizing alternative investments.  

Prioritize– With many across your organization believing that their request is the silver bullet to institutional success, having the proper governance in place to assist in prioritizing and ensuring focus on the identified project is critical.

Engage Operations– Aligning the operational workflow and resources to drive value out of the data requires a significant partnership between operational leadership and information services.  Having well-defined goals and objectives associated with the utilization of the data will keep everyone aligned and understanding of the adjustments that will be required to attain success.  

Measure and Report– In a new environment with theoretical benefits substantiating investments, keeping score and reporting on the project success is critical for leadership to understand future investments in big data.  

Other industries have highlighted and touted individual big data efforts that have advanced their organization’s cause. Healthcare organizations have observed these successes and look to replicate them in order to advance their organization’s mission. As indicated, leveraging big data is perilous and often fraught with failure.  

Working closely with leadership to identify, prioritize and focus on selected projects is just one way to increase your chance for success.

Mike Restuccia is the CIO of Penn Medicine.

UNC Health Care has reached Stage 7, the highest level on the HIMSS Analytics EMR Adoption Model, which measures healthcare facilities on their use of advanced analytics and health information technology. The designation applies to all UNC facilities: its hospitals, physician practices and applied analytics.

"The Stage 7 honors confirm UNC Health Care's place as a national leader in health IT and analytics," UNC leaders said in a statement. "Most importantly, these rankings represent real and meaningful benefits for our patients in terms of quality, safety, and overall care."

UNC Health Care is the only health system in the U.S. to achieve Stage 7 status on all three HIMSS Analytics domains – inpatient, outpatient and analytics.

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

"Achieving Stage 7 recognition further reinforces the success our teams have reached in building an information technology infrastructure that enhances the ability of our providers, care teams, and staff to care for our patients," said UNC's Chief Information Officer Tracy Parham, RN, in a statement.

The Stage 7 designations for UNC Health Care include its hospitals and associated clinics at Caldwell Memorial Hospital in Lenoir, Chatham Hospital in Siler City, High Point Regional, Pardee Hospital in Hendersonville, UNC Medical Center in Chapel Hill and Hillsborough, and UNC REX in Raleigh.

At each of these hospitals, the awards recognize the utilization of a complete EHR infrastructure, including external health information exchanges, advanced data/analytics, and comprehensive plans and support in place for information technology governance, disaster recovery, privacy, and security.

"Starting in 2012 and 2013, our focus centered on establishing system-wide information systems and building baseline capabilities," said Bill Roper, dean of the UNC School of Medicine and CEO of the UNC Health Care System. "Now, just five years later, we are recognized as national leaders in health IT by multiple organizations.

"These rankings represent real and meaningful benefits for our patients in terms of quality, safety and overall care," he added.

UNC Health Care is one of 40 health systems nationwide collaborating with Apple – and one of only 10 in the beta test group – to allow patients to easily download their electronic health record data from the My UNC Chart patient portal and integrate the data with Apple's existing personal data tracking and reporting features in the iOS Health app.

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

As a longtime collaborator with Apple – since before it even beta-tested its Health Records project, live now at 39 hospitals – San Francisco-based Dignity Health is in sync with the iPhone developer's vision, said Shez Partovi, MD.

"We had been working with Apple prior to their initial announcement for some time," said Partovi, chief digital officer and senior vice president of digital transformation at Dignity Health. "We'd been working with them for a while because we're aligned in our philosophies of empowering patients by giving them their data."

As part of the Health Records launch, Dignity will leverage HL7's FHIR standard to securely move patients' health data from own electronic health record system to the iPhones of patients using iOS 11.3 – enabling them manage meds, labs, allergies, conditions and more, and notifying them when the health system makes changes to their health information.

[Also: Apple reveals 39 hospitals to launch Apple Health Records]

"When you think of personalized medicine, you can think about caring for yourself in two dimensions," said Partovi. "There's care management, where a health system or physician or team is managing your care, and there's self-management."

For those patients managing an illness or a chronic condition, "a big part of your life is self-managing that condition," he said.

Luckily, nowadays there are "more and more tools out there that will be enhanced if they have your data." A tool like Apple's Health Records, that puts valuable EHR data right onto a person's smartphone, can only be a boon.

"That, for us, has always been the philosophy," said Partovi. "We recognize that a lot of care happens outside the four walls of a health system. And we believe that for healthy populations we need to give patients their data."

Picking up where Google left off

The idea of personal health record is nothing new, of course. Most providers offer at least a basic patient portal that can be accessed via computer or smartphone, although utilization of them remains underwhelming.

And large consumer-facing companies such as Microsoft and Google tried their own versions of the PHR – HealthVault and Google Health, respectively – both of which struggled to gain traction with the public.

But Partovi says he thinks the new iPhone Health Records initiative will be different.

[Also: Microsoft announces closure of HealthVault Insights app-based machine learning project]

"There are three reasons why Apple is uniquely positioned," he said. "One is the way they approached this whole story, which is by actually moving the data directly from the health system to the device. That's different from what Microsoft and Google tried in the past. It's the data itself. They give the patient their data, not just store it in yet another cloud."

Second, "Once the data is on your device, you have the strength of the App Store. All of the different potential apps will come forward to be able to use your own personal data, to personalize self-management,” he said.

“It's just a click-through to gain access to your data,” Partovi continued. “In the past, the data would be stored somewhere else and you'd need all kinds of HIPAA privacy consents. Here, you can develop a whole new generation of health apps."

Third, he said, is the simple ubiquity and popularity of iPhones, the intuitive nature of iOS software: "Apple's view of the world has always been individual-centric, trying to create a positive experience," he said.

"Those three things make Apple different from everyone else," said Partovi. "They give you your data. They have the strength of the app store to enable third parties to make use of your data to do great things for you. And their philosophy on privacy and individuality is going to make this very different."

Positive results in action

It's early yet, but some anecdotal experience suggests the project might catch on, he said. As soon as the public preview went live, he got a text from a friend who helped care for his mother, who has a chronic condition.

She gets care both at Dignity Health, and also another health system that's taking part in the Apple project. Her son was easily able to download her EHR information from both health systems, directly to her phone.

"He texted me to say it was a jaw-dropping experience for him to look at her phone and see all her records in one location," said Partovi.

Asked what he hopes to accomplish, either in terms of uptake or outcomes, from Dignity Health's participation in this initiative.

"For us, there are things we as a health system want to do, and there are things I hope Apple does," he said. "We're focused on a few patient journeys – patients with asthma, with diabetes, with cardiac conditions – and we will be focusing on those cases, people who we think will benefit immensely from having their data on their own devices."

As for Apple, Partovi is hoping eventually to see the data moving bi-directionally.

"As the patient moves between health systems and changes doctors, we would like to see the ability for the data to go back out," he said. 

"The ideal scenario is that you walk into a clinic, your Wallet wakes up, and you swipe it and it says the clinic would like to get the following information – immunization, labs, medication – and you click, OK, OK, OK and click submit," Partovi added. "That is a transformative experience for the patient, but also for our care system from a workflow perspective."

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

The U.S. Department of Veterans Affairs Chief Information Officer Scott Blackburn resigned late Tuesday night after four years of leadership on a wide range of technology projects under both former VA Secretaries Bob MacDonald and David Shulkin, MD.

Blackburn joined the VA in Nov. 2014 as an adviser to Macdonald and as MyVA Task Force executive director. He also served briefly as the VA's interim deputy secretary. In Sept. 2017, he was named acting CIO and acting assistant secretary of information and technology at the agency.

A new Politico report said President Donald Trump has named his former campaigner Camilo Sandoval as the new acting CIO.

Sandoval, a former Air Force intelligence officer, moved to the VA health administration last year. Reports claimed Sandoval conspired to have Shulkin fired, as the former secretary wouldn't aggressively push to increase private sector care for veterans.

Further, the former director of data operations for Trump's 2016 campaign, reportedly had repeated clashes with career staff during his tenure at the Treasury Department. He was also accused in a recent lawsuit of sexually harrassing a fellow employee during the campaign.

VA officials didn't immediately respond to a request for comment to confirm the staffing changes.

[Also: VA outlines plans to get off GAO high-risk list]

As acting CIO, Blackburn was one of the key leaders of the agency's EHR modernization project. The agency has been in a holding pattern for a number of months on its EHR modernization contract with Cerner. The departure of Blackburn and lack of permanent leadership, especially in the IT department, still leaves the future of its EHR in question.

"My effort has always been about better caring for veterans regardless of presidential administration … I have been honored to serve alongside both in a bipartisan way," he wrote. "I will remain both VA's biggest cheerleader and critic from afar."

Blackburn made the announcement on Twitter, writing: "This is a bittersweet moment in my career. Today, I officially resigned my position at [the VA]. It has been the honor of my life. Too many people to thank. Will continue to advocate for veterans in other ways."

This is a bittersweet moment in my career. Today I officially resigned my position at @DeptVetAffairs. It has been the honor of my life. Too many people to thank. Will continue to advocate for #Veterans in other ways. Next stop - time off for a few months :) pic.twitter.com/qN9HWWocjn

— Scott Blackburn (@Srblackb) April 17, 2018

For now, Blackburn said he will take time off for a few months.

Blackburn's departure is just the latest in a leadership shakeup of the agency. Shulkin's Chief of Staff Viveca Wright Simpson stepped down in February after a VA Office of Inspector General report claimed she doctored an email to secure taxpayer funding for the travel costs of Shulkin's wife during a summer European work trip.

Shulkin was ousted just last month, after reports found the secretary had fallen out of favor with the President and agency infighting. Trump named Department of Defense official Robert Wilkie as acting secretary in the interim while awaiting confirmation of his nominee for secretary, White House Physician Rear Adm. Ronny Jackson. That hearing will be held on April 25.

This story was updated to include President Trump naming his former campaigner Camilo Sandoval as the new acting CIO.

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