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    Other consumer-facing companies, such as Google and Microsoft, have developed personal health record products in recent years, with limited success. Google experimented with the idea but shut it down in 2011 while Microsoft closed down aspects of its HealthVault project earlier this year.

    Today, there are 39 health systems betting Apple's plan for personal health records will work where others didn't. Dignity Health's chief digital officer recently told us the reasons why he thinks it will

    Now it's your turn to weigh in.

    Primary Topic: 
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    Short Headline: 
    Poll: Will Apple Health Records work?
    Newsletter hed: 
    Poll: Is the time right for consumer-facing apps like Apple Health Records to work?
    Newsletter teaser: 
    There are a lot of organizations betting on Apple's plan – now it's time for you to weigh in on the idea.
    HOT @HIMSS: 

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    When choosing a vendor, customers focus on integration, consolidation and functionality, according to a new study from KLAS that looks at how IT decision-makers choose their technologies in different market segments.

    Satisfaction level of existing customers and retention rate (the percent of buyers planning to continue with a given vendor) were also included as reasons.

    The Decision Insights 2018 report draws on the insights of buyers of EHRs, population health platforms, analytics tools, imaging systems and more to track the rationale for the initial acquisition and assess customer satisfaction afterward.

    [Also: Epic Systems lands Best in KLAS award 8th year in a row]

    The report also looks at vendors from nearly two dozen different market segments. It's meant to track the perceptions and plans of potential customers, according to KLAS, and is based on feedback that's reported to the research group when providers have recently purchased or plan to purchase a given piece of software.

    "Decision Insights help provider organizations understand which vendors have market energy and why other organizations are considering these vendors," said KLAS researchers.

    Such "market energy" is based on the number of deals a particular vendor is being considered for, across all segments.

    Together, companies with high market energy, high customer satisfaction and high retention rates earned what KLAS called "A-List" status. Across all market segments, these companies were Carestream, Epic, Health Catalyst, InterSystems, M*Modal, Sectra and Workday.

    There, Epic is perhaps unsurprisingly in the lead (with 393 potential purchases), followed by Cerner (304), athenahealth (129), Meditech (125), Allscripts (72), GE Healthcare (61), eClinicalWorks (45), Merge/IBM (39), and Philips (33). More than two-dozen other companies were under consideration by 30 different buyers or fewer.

    Interestingly, however, the report suggested that market energy and customer satisfaction were not always as closely aligned as one might assume.

    "Consideration rate doesn't necessarily correlate with satisfaction score," according to KLAS. "When making software decisions, provider organizations are only slightly more likely to consider vendors with high satisfaction ratings over vendors with low satisfaction ratings. More often, how frequently a vendor is considered is tied to other factors, such as market share, regional market energy and referrals."

    That said, "vendors with low satisfaction are frequently considered but are not regularly selected," researchers wrote. "When selecting from considered vendors, provider organizations are dramatically more likely to choose a vendor whose customers currently report high satisfaction. For every 1 point increase in satisfaction score, the likelihood that a vendor will be selected goes up 1.3 percentage points.”

    "Healthcare has long been known as a highly connected industry in which a vendor’s reputation matters," they added. "If your vendor is not delivering well for you, they are very likely struggling to sell to new clients. Vendors who expend energy to gain consideration but fail to concentrate on overall customer satisfaction will not see a long-term ROI for their efforts."

    The health IT market segments covered by the report are: 340B Management Systems; Acute Care EMR; Acute Care EMR (international customers); Ambulatory EMR; Cardiology; Emergency Department; Enterprise Resource Planning; Healthcare Business Intelligence & Analytics; Homecare; Laboratory; PACS; PAC (international customers); Patient Accounting & Patient Management; Population Health; Practice Management; Retail Pharmacy - Outpatient; Secure Communications; Small Practice Ambulatory EMR/PM (fewer than 10 physicians); Speech Recognition: Front-End EMR; Talent Management; Virtual Care Platforms; and VNA/Image Archive.

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

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    KLAS report explores health IT buying decisions, customer satisfaction
    Newsletter hed: 
    KLAS report explores health IT buying decisions, customer satisfaction
    Newsletter teaser: 
    The new study takes a broad view of dozens of healthcare market segments, from acute EHRs to virtual care platforms, and assesses the how providers choose vendor partnerships.
    HOT @HIMSS: 

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    Clinical documentation improvement has been a major focus of many health systems' value-based care initiatives. But getting to more efficient and more accurate charting, especially for providers using older electronic health record systems, is a tall task with no dependable template for success

    But in AHIMA's Perspectives in Health Information Management, four experts from the Mayo Clinic College of Medicine showed how their department – the college's Department of Physical Medicine and Rehabilitation – used Lean processes for a redesign of an inefficient, first-generation EHR documentation system.

    The project was a success, at least with respect to a boost in productivity and staff morale.

    [Also: How NYU Langone tweaked its Epic EHR for value-based care, saving millions]

    "The implementation of Lean methodology applied to EHR documentation template inefficiencies proved to be an effective way of reducing time spent in the EHR by therapists, improving therapist productivity, and increasing satisfaction of internal and external stakeholders," said the Mayo Clinic experts.

    Specifically, by bringing Lean methodology to bear on documentation template inefficiencies, Mayo staff were able to reduce time spent in the EHR by therapists, improve therapist productivity and increase the satisfaction of internal and external stakeholders.

    Using Lean processes enabled reductions in time spent using the EHR from 2.8 hours per day to 1.9 hours per day per therapist, the researchers said. It helped increase time spent on direct patient care from 53 percent to 71 percent. And it led to increased satisfaction levels for both internal stakeholders (from 17 percent to 97.4 percent) and external stakeholders (43 percent to 80.3 percent, respectively).

    "Lean methodologies, which have been used for several decades in the industrial sector, are increasingly being applied to healthcare to drive quality improvement in order to reduce or eliminate errors, delays, and redundancy," wrote the Mayo Clinic staffers in the AHIMA article.

    Having identified ongoing EHR limitations in a documentation system designed for inpatient and outpatient physical therapists and occupational therapists, leadership of the Department of Physical Medicine and Rehabilitation through a Lean Six Sigma approach could help – specifically the Define, Measure, Analyze, Improve and Control framework.

    "The central problem identified by rehabilitation therapists when utilizing the original EHR was reliance on a poorly designed documentation template characterized by an excessive amount and redundancy of information, which resulted in a protracted, unclear text rendition," they explained.

    "Rehabilitation therapists, physicians and other providers often described difficulty finding important material in the patient evaluation or treatment notes. Despite the fact that the system was custom-built for the department, neither the end users (rehabilitation therapists) nor the note readers (physicians and other providers) had been included in the initial planning phases, nor had they been given an opportunity to provide feedback on the template design or content."

    The Mayo team identified three big aims for the Lean project: reduce the average amount of time therapists interact with the EHR by 35 percent; increase staff productivity in units of services charged per patient by 10 percent; and improve stakeholders’ satisfaction to 80 percent in the stakeholder satisfaction survey.

    Use of the DMAIC framework led to improvements in those and other areas, but the researchers made sure to point out that, those gains notwithstanding, Lean may not be a cure-all for other challenges related to EHR documentation.

    "Similar efficiencies may be less evident in the areas of documentation creation, readability, and usability of information found in provider evaluations and treatment notes, and reports of increased documentation time have led to reduced direct patient care time," they said.

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

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    Can Lean methodology help improve EHR documentation?
    Newsletter hed: 
    Can Lean methodology help improve EHR documentation?
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    Mayo Clinic researchers write in an AHIMA report that the process technique could improve electronic health record efficiency and overall satisfaction by users.
    HOT @HIMSS: 

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    Rival EHR vendors Epic, Cerner and Meditech all rated well when it comes to client satisfaction in a new a new Black Book survey released Friday but the market is poised for a shakeout as Amazon and Google move into the space and consumer satisfaction demands better technologies. 

    "Patients expect and want to interact more with hospitals through digital channels like email, apps and social media rather than interacting on a traditionally personal level with clinical and financial back office staff," Black Book Managing Partner Doug Brown said. 

    Black Book’s survey found that consumers have little patience with the lack of hospital interoperability, incorrect billing and poor or no access to scheduling and results. 

    [Also: AMA and Google join forces to offer $50,000 in interoperability contest]

    Among respondents, 89 percent of those under the age of 40 are not happy with the technology hospitals have in place, while 84 percent are seeking the most technologically advanced healthcare providers they can find. 

    Yet, in contrast, 78 percent of hospitals responding to the Black Book survey indicate they have not prioritized or budgeted for improvements in patient engagement, interoperability or patient communications for 2018.

    [Also: 5 ways Amazon could disrupt healthcare]

    Brown noted that 88 percent of surveyed consumers blame the hospital system directly -- not the electronic health record systems or financial technology -- for the lack of patient record portability and access among providers. 

    Among hospitals, Epic, Cerner, Meditech and CPSI earned top scores in a separate Black Book poll. That survey noted that interoperability remains a struggle for many, with 36 percent of surveyed medical record administrators reporting difficulties with exchanging patient health records with other healthcare providers, especially between physicians not using the same EHR.

    Thirty-six percent of surveyed medical record administrators reported struggling with health data exchange. The percentage is down slightly from two years ago when 41 percent reported problems.

    All told, the two pieces of research point to an EHR market ripe for 

    “There will be new entrants into the healthcare technology and EHR space like Google and Amazon, who have little hospital technology-based experience but are bringing new processes and transparency, as well as increased competition,” Brown said.

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

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    Black Book: Amazon, Google pose threat to EHR market
    Newsletter hed: 
    Black Book: Epic, Cerner, Meditech take top scores in new EHR survey but Amazon and Google pose threat to market
    Newsletter teaser: 
    Patients are increasingly seeking tech-savvy healthcare providers but the majority are not budgeting for tools that improve engagement or communication with consumers in 2018, opening the doors for major disruption.
    HOT @HIMSS: 

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    When EHRs can learn – gather and remember – what works best for each user, they can attain maximum efficiency.

    As we live in the new world of quality, value-based care, we must be able to draw more insights and conclusions from ever-increasing amounts of information. We have the data, now we must put it to work. When we combine all of this data with machine learning, we are equipped to make smarter decisions. We have the power to transform healthcare – from the way we use electronic health records to the way we predict and deliver care.

    A game changer for EHRs

    Most EHRs are built on technology that is 20 or 30 years old. Generally, EHRs have kept up with rapid changes in healthcare by making incremental improvements over time. But it is challenging to retrofit EHRs to take full advantage of new innovations.

    EHRs must do more than store data. They should be smart enough to deliver the right information at the right time, at the point of care. When an EHR is powered by machine learning, it can pre-populate information based on usage patterns and deliver preference reminders, constantly surveilling trends by user and organization to create opportunities for more effective care.

    Plus, the power of machine learning surfaces information relevant to the encounter in real time, which helps improve quality and immediate interaction with the patient. Ultimately, this reduces the amount of time spent on documentation, helping address the problems of EHR fatigue and caregiver fatigue. That's all extremely important.

    When EHRs can learn – gather and remember – what works best for each user, they can attain maximum efficiency.

    A game changer for precision medicine

    Precision medicine is an epiphany for clinicians and the patients they serve. Now, thanks to machine learning and AI, an individual's unique genetic makeup, environmental factors, lifestyle and family history can be factored into new protocols for an accurate diagnosis, personalized disease treatment and prevention planning.

    Technology now has the power to bring the promise of genomics and precision medicine directly into the clinical workflow, while establishing a foundation for trial and research. This allows the industry to apply new genomic data models in a sensible way — to deliver the right information to the provider at the right time, while creating "research-ready" data to support a variety of objectives.

    This can transform the way we care for a wide range of diseases and conditions – from cancer to hyperlipidemia to diabetes to renal disease to neurodevelopmental disorders. The ultimate goal is to drive better and more accurate diagnoses, treatments and outcomes — while simultaneously making this knowledge available for research and pharmacogenomics.

    A game changer for population health, predictive modeling

    Machine learning is also empowering us to analyze patient data at a level never before possible. We can now transform data into insights and actionable information.

    Just think how a "data lake," where we are able to store millions of de-identified patient information to structure and to analyze data and study problems that are meaningful to health care, could transform diabetes care, for example.

    We now have the power to compare things like blood sugar levels, body mass index, age and other risk factors and analyze treatment outcomes. Then, when clinicians are designing a treatment plan for a single patient, they can look to other similar patients and see which treatments worked well and identify other turning points that result in better, managed care.

    This could be applied to the study of other areas of healthcare as well, including the opioid crisis. We can now couple information that is within the EHR with our "data lake" – and combine it with data that is available through public health mechanisms, such as PDMPs.

    The goal is to develop algorithms to identify or even predict at-risk patients, and look at prescription patterns that most often lead to problems with abuse and overdose. Our research on this is still early, and we are just scratching the surface;  it is clear that this is the direction in which we'll see excellent results.

    The way of the future

    Machine learning brings us an extraordinarily exciting set of capabilities today that didn't exist a decade ago. It enables computers to handle greater amounts of work than human beings can undertake, and will become increasingly important in this era of consumerization. It's making what we do better by improving the overall healthcare experience for both patients and providers.

    Paul Black is the CEO of Allscripts. 

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    Changing the game: Machine learning in healthcare
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    Changing the game: Machine learning in healthcare
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    When EHRs can learn – gather and remember – what works best for each user, they can attain maximum efficiency.

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    Martin Luther King Jr. Community Hospital recently earned a prestigious achievement, attaining Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model – joining just 6.4 percent of American hospitals at the highest level of health IT use.

    The hospital began preparing for HIMSS Stage 7 in early July 2017 and treated the exercise as a formal project, since the requirements to achieve it are so comprehensive. It convened a multi-disciplinary Stage 7 prep team and designated a project manager to lead the effort.

    Martin Luther King Jr. Community Hospital is a new, 131-bed, acute care hospital that opened in May 2015. The hospital's vision is to be a leading model for innovative, collaborative community healthcare, and the health IT strategy was developed to support and enable this vision.

    [Also: HIMSS Analytics unveils new maturity models for infrastructure, supply chain]

    This also informed the guiding principles that governed the design of its EHR and its operating environment. Interoperability, clinical intelligence and bio-med device integration were among the key tenets of its technology plan.

    This plan, combined with best practices for clinical workflow and care coordination, proved to be a winning combination, as evidenced by the hospital's achievement of HIMSS Stage 6 shortly after opening.

    The hospital's HIMSS Stage 7 Prep Team viewed the preparation work as an opportunity to quantify the impact of its EHR design. The team met a variety of challenges to Stage 7 by leveraging resources and existing projects to prepare for the HIMSS Analytics evaluation visit.

    "Once HIMSS Analytics set the date for the evaluation site visit, the hospital HIMSS Stage 7 Prep Team engaged our EMR vendor to help guide preparation efforts," said Tracy Donegan, chief information and innovation officer at the hospital, which uses a Cerner system.

    "The hospital team conducted several meetings with the vendor to perform a detailed review of the Acute Care EMRAM Stage 7 Reviewer's Guide," she said. "Our EMR vendor also provided a sample client presentation so the hospital team could have a sense for the level of detail required for the reviewers on the day of the evaluation site visit."

    To help the hospital team focus, a shell of the client presentation was created. Weekly team meetings were focused on a walk-through of the presentation deck, which served as both a quasi-project plan and a way for the team members to continuously refine their respective sections.

    Finally, the EHR vendor scheduled a mock site visit 45 days prior to the evaluation visit and those findings were used to close minor gaps.

    On another note, the hospital Stage 7 Prep Team collaborated internally with the hospital's quality, infection control, informatics and pharmacy departments to brainstorm on the case studies that best encapsulated the value obtained from its EHR in terms of quality and patient safety.

    "Since the hospital opened with clinical best practices supported by state-of-the-art technology, there weren't many opportunities for dramatic improvement," Donegan said. "Over 15 Lean Six Sigma projects were completed or currently in flight to address operational efficiencies but none of these captured the extent to which technology was being leveraged to support high-quality, high-value care delivery because there was no baseline upon which to draw a comparison."

    Yet this was the story that the team wanted to tell, so they ultimately settled on case studies highlighting quality in medication management, population health and proactive intervention in critical patient care – all in the name of patient safety.

    "As an added bonus, the HIMSS Stage 7 case studies enabled our clinical leaders to present their achievements to a wide audience, in most cases for the first time," Donegan added.

    Further, concurrent with the kickoff for the hospital HIMSS Stage 7 Prep Team was a hospital-wide initiative to achieve more than 95 percent compliance with barcode scanning for patient identification and medication administration. The pharmacy department already had been performing root cause analysis of why some areas were falling short of expectations.

    The hospital team assisted pharmacy with developing and implementing solutions on their findings. The target barcode scanning compliance for patient identification and medication administration was achieved in 60 days.

    "The team leveraged this success to fuel a new initiative on barcode scanning for blood products administration," Donegan said. "The team found that our current blood transfusion reporting capabilities did not accurately reflect or provide enough detail on our scanning compliance so root cause analysis was slow to gain traction."

    To overcome the limitation, the team shadowed clinicians in various departments and found some scenarios where compliance with blood product administration scanning was being underreported and discovered opportunities to educate clinicians on the process.The hospital team developed a custom compliance report and conducted remedial training, which helped the hospital achieve a compliance percentage that was above the HIMSS Stage 7 standard.

    "Our information technology is a foundational component of the hospital's ability to deliver on its mission to provide compassionate, collaborative, quality care and improve the health of our community," said Martin Luther King Jr. Community Hospital CEO Elaine Batchlor, MD.

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

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    Short Headline: 
    How one community hospital earned HIMSS EMRAM Stage 7
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    How one community hospital earned HIMSS EMRAM Stage 7
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    Martin Luther King Jr. Community Hospital shares lessons learned on the strategies it set and the challenges overcame to hit the highest level of IT adoption.
    HOT @HIMSS: 

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    The Illinois Procurement Policy Board is recommending the EHR contract between the University of Illinois Health and Epic be voided due to conflict of interest. 

    The board voted 3-0 this week to forward the case to the state ethics board for review after Cerner appealed the contract award in the fall. UI Health signed a seven-year, $62 million contract with Epic in September to replace its EHR and billing systems.

    The vendor appealed to the state’s Chief Procurement Office for Higher Education shortly after, which was denied. Cerner then appealed to the procurement board.

    Cerner alleged the bidding process was unfair, claiming the contract would cost the state’s taxpayers $100 million. Further, they alleged UI Health’s IT evaluation firm Impact Advisors would benefit if Epic won the contract.

    [Also: New Year's resolution: Dust off that EHR contract to make sure you're as protected as you think]

    Not only that, but Cerner said its bid was $1.5 million lower than Epic’s and included all implementation costs. Epic’s bid did not include those fees. However, Cerner’s bid was evaluated during the hearing and the board found “Cerner did not provide the all-in price that they have claimed.”

    “Something's wrong here," Bill Black, a board member, said in the audio transcript of the board hearing, according to local reports. "I'm not completely comfortable saying there is a conflict of interest, but there certainly may be, and perhaps a hearing before the executive ethics commission could shine more light on this matter than what we're able to do."

    The procurement board's director, Matthew Von Behren, told the News-Gazette that it's unusual for the board to recommend voiding a contract. Those decisions are usually done earlier in the process. The board doesn’t have the authority to void contracts; only the chief procurement officer can.

    ”We defer to the UI Health on the process as it stands,” a Cerner spokesperson responded to a request for comment. 

    An Epic spokesperson said: “UI Health has previously used both Epic and Cerner, and they chose Epic for their system-wide EHR. We believe that organizations have a right to choose the solution they feel best meets their needs. It’s unfortunate that a case of sour grapes is preventing that from happening.”

    The ethics board must review the case within the next 30 days.

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

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    Short Headline: 
    UI Health EHR contract with Epic under ethics review
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    Illinois procurement board recommends voiding UI Health EHR contract with Epic
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    The board couldn’t rule out conflict of interest in the $62 million contract signed between Epic and the academic medical center to overhaul its legacy EHR and billing systems.
    HOT @HIMSS: 

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    The Menninger Clinic, a behavioral healthcare hospital in Houston, Texas, has selected the new Cerner Integrated Behavioral Health model of Cerner Millenium.

    In signing up for Cerner’s hosted electronic health record service, Menninger joins the increasing number of health systems opting for cloud-based EHR, patient portal, revenue cycle management and related services instead of maintaining software on-premise from vendors including athenahealth, Allscripts, Epic, eClinicalWorks, Meditech and others. 

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

    Consultancy Black Book posted new research last week that found Epic, Cerner and Meditech rated highest in customer satisfaction but also suggested that the market is facing disruption from Google and Amazon as patients demand more technology from hospitals. 

    At Menninger, Cerner’s Millennium cloud service will provide care teams with a unified health record. Also, the hospital will deploy Cerner’s portal to give patients and their families access to vital health data and allow for sharing self-reported information, scheduling appointments and communicating with care providers.

    [Also: Black Book: Epic, Cerner, Meditech take top scores in new EHR survey but Amazon and Google pose threat to market]

    The clinic will also roll out Cerner’s revenue cycle management technology to integrate financial and clinical data from the Cerner EHR into one patient record with the goal of making it easier for staff to measure and reduce the cost of care, Menninger said.

    Menninger will also deploy a tailored version of Cerner’s Integrated Behavioral Health cloud-based shared services solution of health IT applications and services. 

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

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    Menninger Clinic to roll out Cerner Millennium EHR in the cloud
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    Menninger Clinic to roll out Cerner Millennium EHR in the cloud
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    Behavioral health clinic becomes the latest provider to turn to the cloud for electronic health record, patient portal and revenue cycle management services.
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    Centers for Medicare and Medicaid Services Administrator Seema Verma on Tuesday announced changes to overhaul the meaningful use EHR incentive program, including equipping patients with access to their electronic health records on the day they leave the hospital.

    Indeed, it starts with a new moniker: meaningful use is being renamed “Promoting Interoperability.”

    The proposed rules and request for comment are a follow up to Verma’s March announcement during HIMSS18 in Las Vegas for better interoperability between providers and for patients.

    Starting in 2019, hospitals are required to have a patient’s electronic health records available on the day they leave the hospital.

    The proposed rule also reiterates the requirement for providers to use the 2015 edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and to avoid reductions to Medicare payments.

    [Also: CMS mandates that hospitals report EHR meaningful use data through secure portal]

    Under Promoting Interoperability, updates to EHR and related technology includes the use of application programming interfaces, or APIs for patients to collect their health information from multiple providers, and to potentially incorporate all of their data into a single portal, application, program, or other software.

    Hospitals can also share data in an API format to develop apps and interfaces.

    CMS is proposing for the inpatient prospective payment system and the long-term care hospital prospective payment system to remove unnecessary, redundant, and process-driven measures from a number of quality reporting and pay-for-performance programs.

    It would eliminate a significant number of criteria acute care hospitals are currently required to report and it would remove duplicative measures across the five-hospital quality and value-based purchasing programs.

    [Also: NQF weighs in on meaningful measures, reducing burden of quality reporting]

    This would result in the removal of a total of 19 measures from the programs and would “de-duplicate” another 21 measures.

    EHRs are worth 40 percent of their score, as the highest rated, must-pass measure, Verma said.

    This results in the elimination of 25 total measures across the five programs, saving hospitals over 2 million hours of work and $75 million.

    CMS is also proposing patients to have better access to hospital price information.

    The proposed rule would require hospitals to post their standard list of prices on the internet and in a machine-readable format, rather than just being required to make them available in some form.

    While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information.

    “We seek to ensure the healthcare system puts patients first,” Verma said. “We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes. Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it.”

    The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant healthcare data.

    CMS is requesting stakeholder feedback through a request for information on revising conditions of participation to revive interoperability as a way to increase electronic sharing of data by hospitals.

    “We’re keeping measures critical to patient safety,” Verma said. “We want comments to make sure we’re striking the right balance.”

    “This payment proposal takes important steps toward a Medicare system that puts patients in charge of their care and allows them to receive the quality and price information needed to drive competition and increase value,” Health and Human Services Secretary Alex Azar said.

    The Tuesday announcement follows Monday’s announcement about other steps including a new request for information on direct provider contracting. With a May 25, 2008 deadline, CMS is also seeking input on the direct provider contracting between payers and primary care or multi-specialty groups for a potential test of a direct provider contracting within Medicare, Medicare Advantage and Medicaid.

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

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    Short Headline: 
    CMS overhauls meaningful use, removes duplicate measures
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    CMS overhauls meaningful use EHR program, renames it ‘Promoting Interoperability’
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    Administrator Seema Verma said changes to the program eliminate 25 measures and ultimately save hospitals over 2 million hours of work.
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    The Veteran Affair's electronic health record upgrade may still be on pause, but the Defense Department's Cerner migration is well underway. And the Defense Health Agency is now seeking information about ways it might best manage and migrate data for its MHS Genesis rollout.

    The DHA has asked its industry partnership network for help with the massive data migration challenges associated with the DoD's big EHR modernization, which is set to continue in nearly two-dozen waves over the next decade, eventually growing even further in complexity with the addition of the Coast Guard and (presumably) integration with the VA.

    As it does, "coordination of reference data tables and mapping of data elements is necessary to ensure consistent and accurate measurement capability and semantic interoperability between component systems through this transformation," according to DHA officials.

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

    As such, it is "interested in learning more about tools to manage the enterprise data management systems for the MHS, and facilitate our ability to meaningfully share data between current systems and the data management systems in our new commercial EHR."

    Its existing data systems currently maintain health records for more than 20 million people, DHA officials said. "Much of the data is in standard code sets (ICD9, ICD10, CPT, MEDCIN, etc.) but there are also tables of system specific institutional data."

    With the continued expansion of MHS Genesis, and added complexity once the Coast Guard and VA are figured in, the volume and variety of that data will increase substantially in the years ahead.

    "As the new EHR generated health data begins to predominate over the next few years, DHA will need reference and metadata management systems able to relate national standard terminology to MHS system usage, and to enable proactive management of measurements from the clinicians' desktop to enterprise dashboard presentation," according to the agency. "The anticipated increase in clinical data from the new EHR, and the need to integrate decades of historical health and business system data, will require a robust enterprise reference and metadata management system."

    Contractors can offer submissions, which the agency says will be used as market research as it considers potential acquisition strategies, until May 4.

    Specifically, it's looking for enterprise reference and metadata management systems that can incorporate national standard terminology in multiple domains to automate mapping of native terms; support customer-specific reference tables for multiple data domains; highlight impacts of terminology changes on dependent measures and value sets and automate the mappings when national standard code sets are updated, officials said.

    The technology should also be able to "interface with Cerner subsystems" – DHA specifically mentions the company's HealtheIntent population health platform – "that may be involved in enterprise data management."

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

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    DoD seeking metadata management systems to help with MHS Genesis
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    DoD seeking metadata management systems to help with MHS Genesis
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    The Defense Health Agency is considering new technology to help it manage the increase in clinical data from its ongoing EHR modernization.
    HOT @HIMSS: 

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    Can predictive analytics, fueled by real-time medical device data, accurately identify patients at-risk for post-op respiratory depression without inducing alarm fatigue in clinicians? 

    That was the question Virtua Memorial Hospital in Mount Holly, New Jersey, and medical device integration and analytics company Bernoulli set out to answer when they embarked on a recently-concluded initiative. 

    Bernoulli's middleware and a rules-based analytics engine were deployed to continuously surveil the patients; it was not only able to able to identify at-risk patients, but reduced false alarms by more than 90 percent, the hospital reported. 

    Here’s a look at how they made it happen. 

    The problem: alert fatigue

    According to the Joint Commission's Sentinel Event database, 29 percent of adverse events in hospitals are related to improper surveillance. The ability to track patients across care settings, continuously integrate new medical devices and distribute real-time patient monitoring to centralized dashboards and mobile devices could have a profound impact for hospitals seeking to create a foundation for addressing other hospital safety issues.

    "As an anesthesiologist, I see a number of opioid-related side effects during the postoperative period, including respiratory depression," said Leah Baron, MD, chair of the department of anesthesiology at Virtua Memorial Hospital. "In our institution, a significant number of our surgical patients are diagnosed with obstructive sleep apnea or suspected to have obstructive sleep apnea. These patients are known to be more susceptible to opioid-induced respiratory depression."

    [Also: UNC Health reaches Stage 7 with advanced EMR, analytics capabilities]

    By observing this subset of patients within the study in the recovery room and on med-surg units, caregivers recognized that better monitoring modalities were needed for early detection of respiratory depression. The goal was to create a safer environment for the unit's high-risk surgical population.

    "The inability to identify respiratory depression early is not just a patient safety problem," said Baron. "Rescuing these patients is also costly in terms of resource utilization, morbidity and mortality. Finding ways to safely monitor high-risk surgical population on med-surg units and decreasing utilization of more expensive beds by this high-risk population could provide significant cost savings for the institution."

    The research set out to determine if selectively delayed notifications using adjustable, multi-variable thresholds to identify clinically actionable events could significantly reduce the overall number of alarms without increasing risks to patients in a post-anesthesia care unit.

    "The study measured pulse, oxygen saturation, respiratory rate, and end-tidal carbon dioxide continuously and compared alarms received through the bedside monitoring device with remote alerts designed to trigger only after a selective delay," according to John Zaleski, executive vice president and chief analytics officer at Bernoulli. 

    The goal, he said, was to "reduce the total number of alarms without increasing risk to patients who have been diagnosed with or are at risk for obstructive sleep apnea."

    Using only sustained alarms as the filter for notifications reduced alerts from 22,812 to 13,000, a number high enough to still cause alarm fatigue. However, passing multiple series of data through a multi-variable rules engine that monitored the values of pulse, oxygen saturation, respiratory rate, and end-tidal carbon dioxide in order to determine which alarms to send to the nurse-call phone system brought the number of respiratory depression alerts down to 209 – a 99 percent reduction, the hospital reported.

    More important, the analytics alerted for every patient that experienced an actual respiratory depression episode, the hospital added.

    "The use of real-time, clinically actionable data requires more than filtering based on alarms and vital signs thresholds," said Zaleski. "Combining analysis with real-time data at the point of collection creates a powerful tool for prediction and decision support."

    Continuous clinical surveillance allows clinical staff to monitor patients remotely. Networked laptop and desktop computers, as well as scrolling message bars, can provide clinical staff with access to data and alarms from all surveilled patients, he said. In addition, alarms can easily be routed to central stations via dashboards or mobile devices and pagers, he added.

    Ultimately, caregivers in the study identified sustained combinatorial alarms that principally combined respiration rate and end-tidal carbon dioxide and that correlated with clinical significance when using the respiratory depression surveillance solution, Baron said. The most significant drop in hypopnea/hypoventilation combinatorial alarm occurred at 18-second alarm delay, reducing the number of alarms from more than 4,500 to 209, she added.

    "An important observation made during this study was that remote alarm communication was an important adjunct to in-room monitoring alarm annunciation," Baron said. 

    "A key argument that is made for in-room annunciation in the case of conscious or waking sleep apnea patients is the room audible alert," she explained. " Yet, in every observed case of opioid-induced respiratory depression, the in-room audible annunciation had no effect on waking or stirring the patients. Hence, the need for a remote monitoring capability to catch such instances is motivated more strongly to ensure patients do not slip through the cracks."

    Hospitals need to take a system-wide inventory of alarms, apply analytics to understand their value and convene project teams to embark on a technology transformation, said Zaleski.

    "This transformation should include the perspectives of frontline clinicians and should respect the significance of disrupting workflows," he said. "Hospitals should employ smart technologies to ensure only actionable alarm signals are sent to clinical staff. The deployment of continuous clinical surveillance requires a careful investment of time and money in addition to workflow considerations to ensure the highest level of patient safety."

    Big Data & Healthcare Analytics Forum

    The San Francisco forum to focus on utilizing data to make a real impact on costs and care June 13-14.

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

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    What are Informatics Nurses and why do they hold such importance in the healthcare setting? As the mediators between both patient care and health IT, these clinicians are vital for the successful delivery of care. Whether you are in the beginning stages of your nursing career or seasoned in the field, this webinar will demonstrate the value of a nurse informaticist in any care setting. In conjunction with National Nurses Week, learn about the foundations of nursing informatics, the value they hold in both health IT and the healthcare setting, and ways that healthcare organizations can use to develop an engaged nursing informatics culture. Influence, Inspire, Innovate.

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    What are Informatics Nurses and why do they hold such importance in the healthcare setting? As the mediators between both patient care and health IT, these clinicians are vital for the successful delivery of care. Whether you are in the beginning stages of your nursing career or seasoned in the field, this webinar will demonstrate the value of a nurse informaticist in any care setting. In conjunction with National Nurses Week, learn about the foundations of nursing informatics, the value they hold in both health IT and the healthcare setting, and ways that healthcare organizations can use to develop an engaged nursing informatics culture. Influence, Inspire, Innovate.

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    Nursing Informatics (NI) is the gateway between IT, patient care, and the interprofessional clinical team. As a broad specialty ranging from an NI Specialist to a chief nursing informatics officer, it is important that careers in this field are recognized and valued in any healthcare setting. Technology is constantly evolving and these nurses face healthcare IT issues head-on to ensure that consumers and patients alike are receiving the most quality care. In conjunction with National Nurses Week, this webinar focuses on the various roles of an NI, the value of nursing informatics, and how you identify yourself as nurse-whether you are new to nursing informatics or lead on an executive level. Influence, Inspire, Innovate.

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    Nursing Informatics (NI) is the gateway between IT, patient care, and the interprofessional clinical team. As a broad specialty ranging from an NI Specialist to a chief nursing informatics officer, it is important that careers in this field are recognized and valued in any healthcare setting. Technology is constantly evolving and these nurses face healthcare IT issues head-on to ensure that consumers and patients alike are receiving the most quality care. In conjunction with National Nurses Week, this webinar focuses on the various roles of an NI, the value of nursing informatics, and how you identify yourself as nurse-whether you are new to nursing informatics or lead on an executive level. Influence, Inspire, Innovate.

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    The House Appropriations Committee on Military Construction and Veterans Affairs voted to fund the VA’s planned EHR modernization project with $1.2 billion for fiscal year 2019 -- and laid down clear direction that VA must adopt the same EHR as the Department of Defense without actually naming Cerner

    The legislation, in fact, foretells that VA will sign the currently paused modernization contract with Cerner. EHR funding will drive implementation that “is identical to one being developed for the Department of Defense,” according to the funding bill. “These two identical systems will ensure our veterans get proper care, with timely and accurate medical data transferred between the VA, DoD and the private sector.” 

    While the funding is no doubt welcome to the VA, it does come amidst a serious time of change.  

    VA has seen a number of leadership moves in the last month, with the firing of VA Secretary David Shulkin, MD, and Acting CIO Scott Blackburn stepping down last week. DoD official Robert Wilkie was named acting secretary in the interim.

    President Donald Trump nominated White House Physician Navy Rear Adm. Ronny Jackson, MD, to replace Shulkin. But his confirmation, scheduled for Wednesday, has been delayed over allegations that include work misconduct.

    Prior to being ousted, Shulkin had intended to sign with Cerner in the fall, but put the contract on hold due to interoperability concerns.

    EHR modernization is only one piece of the VA funding. The agency will receive a total of $194.5 billion in both discretionary and mandatory funding, $9 billion more than fiscal year 2018, much of which is allocated to increasing care access to services for veterans.

    “Providing critical resources for the men and women of our Armed Services and their families is a top priority,” Committee Chairman Rep. Rodney Frelinghuysen, R-New Jersey, said in a statement. “We owe it to those who serve and fight for our freedom every day to ensure they have the necessary tools and support to do their jobs.”

    The $1.2 billion in EHR funding will be available to the agency through 2021, provided the VA gives the committee provides “quarterly reports detailing obligations, expenditures and deployment implementation by facility.” 

    Twitter: @JessieFDavis
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    Mayo Clinic is just days away from rolling out Epic’s EHR at its Rochester, Minnesota, headquarters. 

    The May 5 go-live will advance an enterprise implementation that is estimated to cost $1.5 billion and began when Mayo and Epic started collaborating in 2013.

    By 2015, Mayo CIO Christopher said the organization would move from Cerner and GE to a single Epic electronic health record. 

    While Mayo has already implemented Epic at several sites in Wisconsin, the headquarters roll-out is a major milestone, with final sites in Arizona and Florida slated to follow in October 2018. 

    As is the case with multi-billion dollar software projects, the arrangement between Mayo and Epic includes several nuances about data centers, public-facing educational products and apps as well as integrating technologies. 

    Here’s a look at key milestones for this massive project. 

    July 13, 2017
    Mayo Clinic officially hit a milestone in its Epic implementation when 24 of its sites in Wisconsin went live on July 8, 2017, and the system said that campuses in Minnesota were scheduled to do the same in November 2017. Mayo said at the time that it dubbed the massive initiative the “Plummer Project” in honor of Henry Plummer, MD, for creating the world’s first patient-centered health record more than a century earlier at Mayo.

    September 18, 2017
    Mayo and Epic integrated Mayo's symptom checker functionality into Epic's MyChart portal. The Symptom Checker tool uses algorithms to help both caregivers and patients learn more about common ailments including anxiety, dizziness, swelling, and others. In certain cases, uses can also learn about self-care options. 

    April 26, 2017
    In an effort to give patients access to more information about symptoms, conditions and healthy living, Epic added Mayo Clinic added educational health information to patient-facing apps. "Making Mayo Clinic's health knowledge available within MyChart and MyChart Bedside can help patients understand and better manage their health and well-being," Epic President Carl Dvorak said.

    January 6, 2016
    The hospital-tech vendor relationship took an interesting twist when Epic paid $46 million to buy Mayo’s datacenter so it could turn around and lease the facility and technologies back to Mayo -- a move that CIO Ross described as “an important foundation” on which Mayo would continue innovating, both within and outside the EHR. 

    February 2, 2015
    Mayo CIO Christopher Ross said the health system has been steadily working to converge its practices for many years, including operations in Arizona, Florida and the Midwest, and in the spring of 2013, it took a very serious look at what the technological infrastructure it needed to advance knowledge sharing inside and outside Mayo. “We have a lot of activity in that space. The EHR is not central to that mission, but it is strongly supporting our long-term goals to do that,” Ross said, adding that “this technology commitment is very longstanding.” 

    Twitter: @Bernie_HITN
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    The Centers for Medicare and Medicaid Services late Tuesday announced substantive changes to the meaningful use program and while hospitals appreciate one of them, two others are drawing less enthusiasm. 

    Specifically, CMS is aiming to reduce regulatory burdens on clinicians and hospitals, but the agency is also proposing that they equip themselves, technologically and policy-wise, to grant patients access to their data in EHRs and post pricing for care services in a way consumers can understand. 

    Let’s take a look at how experts have reacted so far. 

    First, what hospitals like

    The new rule is designed to reduce regulatory burden on hospitals. No surprise, the initial response tends to be positive, with the American Hospital Association saying its members appreciate the several steps CMS took to ease such burdens. 

    Last year, the AHA reported that providers spent close to $39 billion in one year solely on administrative duties related to regulatory compliance. So it follows that healthcare organizations would also be pleased CMS eliminated 25 total measures, saving hospitals over 2 million hours of work and $75 million, the agency said. 

    The agency also said it would permanently revoke the 25 percent rule for long-term care hospitals, set to kick in on Oct. 1, which would reduce LTCH Medicare reimbursement to equal that of the amount under the inpatient prospective payment system for acute care hospital that refer more than a quarter of their patients to long-term care facilities.

    AHA also supports CMS’s more streamlined approach to quality measurement by eliminating a significant number of criteria acute care hospitals are currently required to report and it removes duplicative measures across the five hospital quality and value-based purchasing programs. 

    Also in the proposed rule, for the first time, CMS included a couple of bonus measures for opioid use disorder treatment.

    But hospitals aren’t quite as excited about two other plot twists in the proposed rule. 

    Now, about EHR interoperability and pricing transparency

    Whereas CMS intending to reduce regulatory burden will almost always go over well among the regulated, requiring improved patient access to EHR data and making hospitals post their prices for more effective price transparency are, not surprisingly, thus far having a different impact. 

    Hospital associations, in fact, have yet to publicly weigh-in on this part of the rule -- but it is expected to solicit comments in CMS’s request for feedback by the June 25 deadline. 

    For one thing, what a patient pays for services is just as much a reflection of his or her health insurance coverage as it is the result of chargemaster pricing, according to Jay Deady, CEO of Recondo Technology, which deals in price transparency.

    Patients deserve an accurate understanding of what their bill for services will be, Deady said.

    “But posting a chargemaster list online won’t give patients this insight,” Deady said. “That’s because what the patient will pay is dependent on his or her real-time levels of insurance coverage, which is a variable that a ‘one size fits all’ list of prices doesn’t reflect.”

    On the interoperability front, hospitals by 2019 will also need to meet standards of making access to their EHR data available for patients on the day of discharge.

    The American Hospital Association had no comment on this part of the rule either, but said it was disappointing that the agency would require the use of 2015 edition EHR technology beginning in 2019. 

    EHR technology is part of demonstrating meaningful use -- now being called promoting interoperability -- to qualify for incentive payments and to avoid reductions in Medicare payments. 

    The new requirements affect eligible hospitals and critical access hospitals participating in the Medicare and Medicaid EHR incentive program. 

    Twitter: @SusanJMorse
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    The Centers for Medicare and Medicaid Services effort to reduce regulatory burdens are being warmly received but the industry appears less excited about price transparency and patient access to EHR data stipulations.
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    When then-President George W. Bush called for “computerizing health records” in 2004, only one in 10 U.S. hospitals had an electronic health record. Ten years later, thanks in large part to the HITECH Act, the EHR adoption rate had risen to 95 percent. Yet despite the near tenfold increase in adoption rates, the original goals of EHR implementation – “to avoid medical errors, reduce cost and improve care” – remain stubbornly out of reach.

    How did this happen? A recent study published in Health Affairs suggested that by rewarding minimal information-sharing between providers rather than ensuring data integration, government incentives put the cart before the horse.

    “Progress is focused on moving information between hospitals,” the study’s authors concluded, and “not on ensuring usability of information in clinical decisions.”

    The goal: contextual, intuitive data

    Kathy Nieder, a family medicine physician and EHR physician liaison with Baptist Health Kentucky, encounters siloed, unusable data on a near-daily basis.

    “Healthcare is still in the 20th century where data is concerned – nothing is searchable; no data is discrete; I can’t easily communicate with other physicians in other institutions,” Nieder said. “Imagine getting a 600-page scanned PDF file of a patient’s previous care when all you need to know is when his or her last colonoscopy was or if he or she ever had a pneumonia shot.”

    Although Nieder spends half her working day helping colleagues use the system’s EHR more efficiently, even she struggles to get the right data at the right time. “On a day-to-day basis, my clinical optimization goal is for the major source of my interaction with systems – the EHR – to be an intuitive tool that doesn’t require the majority of my time and attention.”

    Nieder’s goals for clinical optimization are seconded by Ash Goel, MD, the system CIO at Bronson Healthcare in southwest Michigan. “We define clinical optimization as an ongoing process of improving any and all technology tools that clinicians use to manage care and the work that they do, day in and day out,” he said.

    This is especially important to a fast-growing provider like Bronson, which now comprises 70 ambulatory locations, four acute care locations and an academic affiliation with a medical school. Every time the system acquires a new practice or tool, opportunities for improving clinical workflows and better end-to-end care arise.

    But that doesn’t mean that Goel subscribes to a “more is better” approach to data. In fact, at the recent HIMSS Global Conference & Exhibition, he met with executives from his EHR vendor and pleaded with them to reduce the amount of information they present to clinicians.

    “We have so much data that we put in front of clinicians that it is underutilized, or the important stuff gets missed because it’s so overwhelming,” Goel said. “How can we optimize what we present to clinicians so that the most important data is automatically highlighted, more context-aware and sent to the right people in the appropriate context?”

    People, processes and technology

    Clinical optimization typically falls on the shoulders of existing IT staff. “We have a large IT department who takes on the direct responsibility of getting systems to talk to each other,” said Nieder. “We just implemented Epic a little over two years ago, so now it is working on getting all the peripherals that are part of the Internet of Health Things to work with Epic.”

    But technology changes and enhancements are just one component of optimization. To fully leverage the EHR and the data within, optimization requires a broader approach that also seeks to make an organization’s people and process as effective and efficient as possible.

    “Optimization requires close collaboration across an organization,” said Donna Morrow, RN, clinical service line director, at Leidos. “A strong governance structure is essential, and the effort should include stakeholders from various areas of the organization such as clinicians, IT, finance, billing, patient access, operational management and the business office.”

    Taking a holistic, strategic and collaborative approach to optimization can help organizations move beyond the initial benefits achieved with the EHR and start realizing improvements in adoption, physician satisfaction, workflow efficiency and care coordination. “Ultimately,” Morrow stressed, “that is what creates real clinical value and improves patient care.”

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    Cape Fear Valley Health, a 916-bed regional health system based in Fayetteville, North Carolina, has chosen Epic for a new initiative to unite all of its hospitals and clinics onto a single platform.

    Its hospitals include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Hoke Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care and Bladen County Hospital.

    In what could be taken as a taste of what’s to come in the electronic health record space, rather than referring to Epic’s software as an electronic health record, Cape Fear Valley used Epic's own recent coinage – comprehensive health record – to describe the new IT system it will roll out over the next year, with an expected completion by summer of 2019. 

    [Also: UCSF researchers take issue with Epic's 'CHR' definition, offer alternate meaning]

    While Epic CEO Judy Faulkner was the first to publicly say that the term EHR should be replaced with CHR, rival tech vendor executives Cerner President Zane Burke, eClinicalWorks Chief Executive Officer Girish Navani and athenahealth Chief Product Officer Kyle Armbrester all said they are already moving in the same direction. 

    That essentially means broadening the types of information that the health record system includes and accesses, with a focus on social determinants of health, patient-generated health data, as well as greater connectivity and interoperability. 

    Faulkner said the difference between EHRs and CHRs comes down to three big issues

    "The first is that there’s information that’s not in the EHRs now," Faulkner said. "The second one is care that is not in the hospital but has to be part of the picture. We bring them in the Comprehensive Health Record which should be the comprehensive health record – social and community care. And the last is traditional healthcare within the walls that has now moved out of the walls."

    At Cape Fear Valley, the move to a CHR is meant to be all-inclusive, expanding beyond clinical settings to span the continuum of care, from the reception desk to the patient's home, with Epic’s MyChart patient portal, according to the health system. 

    As the new platform rolls out, officials said it will replace two Cerner record systems in use at Cape Fear Valley. The goal is a streamlined scheduling and billing process, with new clinical applications and population health software.

    Cape Fear Valley said it's deploying the new Epic CHR for its million-plus patients – many of whom are veterans – across a seven-county region North Carolina that it serves.

    "Epic will allow Cape Fear Valley Health caregivers to share critical patient data across our facilities, our region and throughout the United States, with both civilian and military health are providers," said Samuel Fleishman, MD, the health system's chief medical officer. Cape Fear Valley CEO Michael Nagowski added that Epic’s CHR will enable patients to access their data. 

    Twitter: @MikeMiliardHITN
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    It’s very difficult for physicians and other frontline caregivers to get complete pictures of patients’ healthcare, of course, since patients so often receive care at multiple locations whose IT systems may not be interoperable.

    But the University of North Carolina Health Care is making great strides in this area, culling data from external sources and pulling it into its Epic electronic health record by using a special technology design philosophy from Epic called Happy Together.

    For example, as of Jan. 31, 2018, for the diabetic A1c test, 5,120 external completions out of 42,619 total completions were pulled into UNC’s EHR; that’s 12 percent of completions due to external data. Patients who have diabetes or prediabetes should get Hemoglobin A1c testing at regular intervals. Of the patients who have this completed or are up to date, 5,120 are due to external data out of 42,619 total completions.

    [Also: UNC Health reaches Stage 7 with advanced EMR, analytics capabilities]

    As of the same date, for flu vaccines, 15,004 external completions out of 185,021 total completions were pulled into UNC’s EHR; that’s 8.1 percent of the completions due to external data. For the current flu season, if one looks at all patients eligible for this health maintenance topic and one looks at the patients who have gotten their flu shot this season, 15,004 patients had an external flu shot or entered it via My UNC Chart out of 185,021 patients who had their flu shot completed.

    “We know that many patients receive care scattered across multiple providers and health systems,” said Robb Malone, vice president of practice quality, innovation and population health services at UNC Health Care. "Coordinating care across the continuum is necessary in order to sustain the health and well-being of the patients we serve.”

    The availability of data from multiple health systems directly in the patient’s chart improves UNC’s ability to care for its patients and helps reduce redundant or unnecessary testing, which prevents inconvenience and/or pain for the patient; saves healthcare dollars for patients, insurers and care providers; and saves time for both the patient and provider, Malone added.

    “The availability of A1c data from multiple health systems is a great example and a major development in the management of diabetes,” Malone said. “Using the additional data now made available in the patient’s chart, providers can coordinate care more proactively and ensure we meet the needs of our patients based on their full clinical history.”

    Happy Together is a design philosophy. It refers to how Epic blends natively documented data with externally documented data into a single, integrated picture, to improve patient care and care coordination. Data is woven together into a comprehensive narrative for clinicians, care managers, community members and patients, according to Epic.

    Specifically, some EHRs treat outside data as separate standalone documents, very similar to an electronic version of a fax. Such an approach introduces usability challenges as clinicians and caregivers must scan through sometimes voluminous documents to get a full picture of a patient’s care.

    Happy Together extracts the discrete facts from these documents and presents these facts interwoven with native documentation, removing duplicates and creating a single problem list, medication list and more, according to Epic.

    But the integration goes beyond the view. For example, calculating a patient’s clinical risk needs to take into account the patient’s full clinical picture, which is difficult to do when the patient receives care across many organizations.

    Epic’s risk scoring algorithms can calculate based on non-native documentation, like the number of emergency department visits the patient has had – regardless of whether the emergency departments use the same EHR – and information about their clinical conditions that might not be known to the local system, Epic said.

    “Integration of the data can be separated into two parts,” said Mike Plesh, director of information technology in UNC Health Care’s information services division. “The configuration and the connectivity. The configuration was the complex part, where the Epic@UNC EHR teams had to map the individual data fields so they match the mappings that are to be used across the other Epic organizations.”

    This was achieved through a workgroup consisting of all Epic partners across North Carolina to create the common values to be used in the data exchange. Epic sees Happy Together as a philosophy because it requires collaboration and agreement across many organizations. The connectivity was the less complex part of the project because it uses the already existing Care Everywhere model that allows for the sharing of patients across Epic organizations, Plesh explained.

    North Carolina’s health information exchange, NC HealthConnex, had a role to play, too. 

    “UNC Health Care is a foundational partner with NC HealthConnex and has had the opportunity to improve how data is shared with them and all Epic organizations across North Carolina,” Plesh explained. “One of the features UNC Health Care and Epic helped collaborate on with NC HealthConnex was a way to determine if an organization is using Epic as the EHR and, if so, to not return other Epic data back to another participating Epic client.”

    The reason for this is because the data is already being shared through the Epic-to-Epic Care Everywhere functionality and the organizations did not want duplicated data returned. Where the organizations get the benefit from NC HealthConnex is by being able to integrate non-Epic organizations’ data into their Care Everywhere screens and providers can consume it in the same manner as if the data came from an Epic organization.

    UNC Health Care learned a variety of lessons along the way during this hefty project, and shares some with the industry at large.

    “Data mapping is complicated but really important,” said Annie Whitney, program manager of population health solutions on UNC Health Care’s practice quality, innovation and population health services team. “In order for this to work, trading partners have to work together on data configuration and mapping so the data shared is usable. We’ve also reached out to the NC HealthConnex about data mapping.”

    Feedback also is an important lesson learned, according to Whitney. Clinicians like the integrated views, and seeing visits and notes from external organizations in-line with UNC information; this saves time and prevents them from having to go back and forth into different screens, she said.

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    Sen. Patty Murray, D-Washington, questioned the current progress of the initial Department of Defense EHR rollout at four test sites in the Pacific Northwest and suggested that tech issues are putting patient lives at risk.

    During the Senate Committee on Appropriations meeting on Thursday, Murray spoke candidly to Stacy Cummings, Defense Healthcare Management Systems program executive officer, about the still unresolved “backlog of issues.”

    “I was very concerned when I started hearing disturbing reports about the rollout plagued by technical problems," Murray said. "These issues have made a significant morale impact on the practitioners in my state, not to mention serious concerns about putting patients’ lives at risk.”

    “I heard issues about inaccurate prescription submissions, misdirected patient referrals, long waits to resolve problems in the program that were identified by the clinicians, and some practitioners reported that they couldn’t even open the program in a timely manner,” she added. 

    Also troubling Murray were reports that staff have been inadequately trained to use the system and “fear they may have to take money out of their own operating budget to pay for that training.”

    In her defense, Cummings told Murray that DoD just completed an eight-week optimization period that began in January. Officials worked to resolve trouble tickets or user complaints, along with support requests from users.

    [Also: DoD-Cerner EHR project finding improvements, despite some challenges]

    “When we began the optimization period, we had about 7,000 trouble tickets. Out of those 7,000 tickets, we’re in the process of closing about 1,000 of them,” Cummings said. “Depending on the level of complexity and how much work needs to be done directly with the user, those changes will be made over the remainder of the year.”

    But Murray continued to press the point: Those issues “were identified long before deployment and should have been addressed prior to people all of a sudden using it when people’s lives are at stake.”

    Cummings said that the four pilot sites are meant to be a starting point to assess the system and infrastructure before full deployment. Both the lessons learned and user feedback will help DoD “make adjustments to software, training, and workflows and be confident the changes are positive and impactful.”

    DoD has maintained the initial deployment has been successful, despite numerous reports that pointed out user complaints and concerns over patient safety. During that period, a DoD official told Healthcare IT News the assessment period was planned and that the issues were to be expected given the complexity of the rollout.

    Project managers have been addressing those concerns and DoD had expected that they would need to make adjustments to the system. At the moment, the agency is in a critical review stage.

    “Successful deployment of MHS Genesis to our four IOC sites was an important milestone in implementing what will be the largest integrated inpatient and outpatient EHR in the United States,” Cummings said.

    Cummings also told the committee on Wednesday that deployment of MHS Genesis will continue in 2019. Full deployment is expected by 2022.

    “I just don’t want everybody to think this is happy-dappy, rosy,” said Murray, “because there are a lot of issues that need to be addressed and we need to stay on top of this.”

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

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    Senator blasts DoD EHR rollout as 'putting patient lives at risk'
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    While the Defense Department has hailed the pilot stage of its Cerner EHR implementation as successful, Sen. Patty Murray outlined a list of concerns over tech issues.
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